Provider Demographics
NPI:1154456739
Name:LAZARUS, DANIELLE MARISSA (MS)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MARISSA
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W FLETCHER ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6490
Mailing Address - Country:US
Mailing Address - Phone:773-573-7091
Mailing Address - Fax:
Practice Address - Street 1:1300 W FLETCHER ST APT 2E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6490
Practice Address - Country:US
Practice Address - Phone:773-573-7091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist