Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 071007565 | IL |
N | 103TC0700X | Clinical Psychologist | 071007565 | IL |
Y | 103G00000X | Clinical Psychologist | 20042454A | IN |
Y | 103TC0700X | Clinical Psychologist | 20042454A | IN |
NPI | 1003045477 |
---|---|
Provider Name | Dr. Ann M Lafrance |
First Address | Merrillville, IN 46410-8602 |
Second Address | Merrillville, IN 46410-8602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 16/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
071007565 | LICENSE (01) | IL |
20042454A | INDIANA CLINICAL PSYCHOLOGY LICENSE (01) | IN |