Search › Illinois › 101YA0400X
Lacey Longo
NPI 1558221895 · on the registry since 2025 · sole proprietor
Practice
- Address
- 1311 N 1720th Ave
Fowler, IL 62338 - Phone
- (217) 506-2788
Registry record
- Primary taxonomy
- 101YA0400X
101YA0400X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2025-11-19
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois