CAROL EVA TALISSE LAICH Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****70

License Status

ACTIVE

Business

First Name

CAROL

Middle

EVA TALISSE

Last Name

LAICH

Business Name

CAROL EVA TALISSE LAICH

Original Issue Date

05/04/2009

Effective Date

12/06/2023

Expiration Date

03/01/2026

City

CHICAGO

State

Zip

60625

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025