Active NPI
Lacey Anderson
- School Psychologist
- Morris, IL
National Provider Identifier
1801306733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 1880939
- Practice address
- 4040 N Division St
Morris, IL 60450-9357 - Phone
- (815) 416-1749
- NPI assigned
- Oct 5, 2017
- Last updated
- Oct 5, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 1880939 | IL | Primary |
Addresses
Primary practice location
4040 N Division St
Morris, IL 60450-9357
Mailing address
4040 N Division St
Morris, IL 60450-9357
Phone (815) 416-1749
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1880939 | IL | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507161600000",
"number": "1801306733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4040 N DIVISION ST",
"city": "MORRIS",
"state": "IL",
"postal_code": "604509357",
"telephone_number": "815-416-1749"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4040 N DIVISION ST",
"city": "MORRIS",
"state": "IL",
"postal_code": "604509357",
"telephone_number": "815-416-1749"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "LACEY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-05",
"last_updated": "2017-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "IL",
"license": "1880939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morris, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.