MEDICARE: LAUREN O'GORMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1306585708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN O'GORMAN

Provider Business Mailing Address
First Line	:	51 S SURREY HILL CT
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1237
Country	:	US
Telephone Number	:	708-954-6387
Fax Number	:

Provider Business Practice Location Address
First Line	:	11755 SOUTHWEST HWY
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1015
Country	:	US
Telephone Number	:	888-329-4535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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Directions to “ LAUREN O'GORMAN ” Practice Location

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