Provider Demographics
NPI:1285170803
Name:CEDILLO, LAMIE
Entity type:Individual
Prefix:
First Name:LAMIE
Middle Name:
Last Name:CEDILLO
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 1:317 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-1924
Mailing Address - Country:US
Mailing Address - Phone:815-217-1421
Mailing Address - Fax:
Practice Address - Street 1:317 TERRACE DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-1924
Practice Address - Country:US
Practice Address - Phone:815-217-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-07
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency