Provider Demographics
NPI:1215464714
Name:LAMPLEY, ANDREA ROSE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ROSE
Last Name:LAMPLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 S LAKE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-1460
Mailing Address - Country:US
Mailing Address - Phone:773-573-7501
Mailing Address - Fax:
Practice Address - Street 1:1207 W LELAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7043
Practice Address - Country:US
Practice Address - Phone:773-334-7117
Practice Address - Fax:773-033-4072
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19938101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)