Abigail Diane Lake, DNP, PMHNP-BC

Key facts

NPI: 1730669409
Entity type: Individual (NPI type 1)
Primary specialty: Psychiatric/Mental Health Nurse Practitioner 363LP0808X
License: 209.028520 (IL)
Practice address: 8616 Northern Ave
Rockford, IL 61107-5309
Phone: (815) 399-9700
Fax: (815) 394-1401
NPI assigned: Aug 21, 2018
Sex: Female
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Aspen Counseling & Consulting LLC Community/Behavioral Health Agency · Rockford, IL · NPI 1326288994

Medicare reassignment Care Compare group NPD IL
Aspen Counseling and Consulting LLC Mental Health Clinic/Center (Including Community Mental Health Center) · Madison, WI · NPI 1407287394

NPD

Medicare Care Compare profile

Specialty: Nurse Practitioner
Education: Other, 2023
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Telehealth: Offers telehealth services
Group practices: Aspen Counseling and Consulting LLC (13 clinicians)

Practice addresses (Care Compare)

8616 Northern Ave
Rockford, IL 61107-5309
Phone (815) 399-9700

Medicare participation

Medicare fee-for-service enrollment: Enrolled in IL
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20240119003672	IL	Practitioner - Nurse Practitioner	6204288798	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
041404632	IL	MD	Addiction (Substance Use Disorder) Registered Nurse
209.028520	IL	MD	Psychiatric/Mental Health Nurse Practitioner

Practice roles

Organization	Specialty	Status	New patients
Aspen Counseling & Consulting LLC		Current since Jan 1, 2024	Accepting new patients
Aspen Counseling and Consulting LLC		Current since Jan 1, 2024	Accepting new patients

Locations

8616 Northern Ave
Rockford, IL 61107
Phone (815) 332-8003

1021 N Mulford Rd
Rockford, IL 61107
Phone (815) 387-5600

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Addiction (Substance Use Disorder) Registered Nurse	163WA0400X	041404632	IL
Psychiatric/Mental Health Nurse Practitioner	363LP0808X	209.028520	IL	Yes

Addresses

Primary practice location

8616 Northern Ave
Rockford, IL 61107-5309

Mailing address

1021 N Mulford Rd
Rockford, IL 61107-3877

Other providers in Rockford, IL

All providers in Rockford, IL · Psychiatric/Mental Health Nurse Practitioner in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.