Provider Demographics
NPI:1588289805
Name:LANTZ, JOY
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:LANTZ
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 1:6645 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2625
Mailing Address - Country:US
Mailing Address - Phone:708-209-5671
Mailing Address - Fax:
Practice Address - Street 1:14512 JOHN HUMPHREY DR STE 2
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2913
Practice Address - Country:US
Practice Address - Phone:708-316-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental Hygienist
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty