Provider Demographics
NPI:1659643971
Name:LACKEY, KAMEESHIA (MA)
Entity type:Individual
Prefix:MISS
First Name:KAMEESHIA
Middle Name:
Last Name:LACKEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6072
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60204-6072
Mailing Address - Country:US
Mailing Address - Phone:312-869-9482
Mailing Address - Fax:
Practice Address - Street 1:1703 MADISON ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2037
Practice Address - Country:US
Practice Address - Phone:312-869-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst