Lacey Lynn Longo, is a
Counselor - Addiction (substance Use Disorder) based in Fowler, Illinois. Lacey Lynn Longo is licensed to practice in Illinois (license number CADC-45328) and her current practice location is
1311 N 1720th Ave, Fowler, Illinois. She can be reached at her office (for appointments etc.) via phone at
(217) 506-2788.
NPI number for Lacey Lynn Longo is 1558221895 and her current mailing address is 1390 Market St Ste 200, San Francisco, California. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1558221895.
Healthcare Provider's Profile
| Full Name | Lacey Lynn Longo |
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| Gender | Female |
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| Speciality | Counselor - Addiction (substance Use Disorder) |
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| Location | 1311 N 1720th Ave, Fowler, Illinois |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1558221895
- Provider Enumeration Date: 11/17/2025
- Last Update Date: 11/19/2025
Medical Identifiers
Medical identifiers for Lacey Lynn Longo such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1558221895 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CADC-45328 (Illinois) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Lacey Lynn Longo is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Lacey Lynn Longo, 1390 Market St Ste 200, San Francisco, CA 94102-5404 Ph: () - | Lacey Lynn Longo, 1311 N 1720th Ave, Fowler, IL 62338-1016 Ph: (217) 506-2788 |
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