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Lafayette R Bagley

Social Worker

Behavioral Health & Social Service Providers

2071 N Southport Ave, Chicago, IL 60614-4015

PECOS Enrollment

This provider is enrolled in PECOS as LAFAYETTE BAGLEY.

Based on the most recent information from CMS, provider Lafayette R Bagley is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1285399576
Provider Type
Individual
Full Name
Bagley, Lafayette R
Credential
LCSW

Gender
Male
Sole Proprietor
No
Enumeration Date
11/2/2021
Last Updated
2/2/2024

Contact Information

Practice Location

2071 N Southport Ave, Chicago, IL 60614-4015

(312) 761-4707

Unlisted Fax

Mailing Location

6450 N Bell Ave Apt 1, Chicago, IL 60645-5583

(312) 731-3625

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 149.026408 Illinois

Lafayette R Bagley

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Entler, Diandra

Sancen, Silvia

Jacobson, Rebecca Wolf

Sutton, Katherine B

Shovers, Samuel

Hunt, Sarah

Varol, Andrea Gail

Dominis, Roxanne B

Mandler, Phyllis

Dolce-Brouwer, Lynne Ellen