MEDICARE: DAMONTE LOWERY

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	:	1649001280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMONTE LOWERY

Provider Business Mailing Address
First Line	:	5113 S HARPER AVE STE 2C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 CLEVELAND ST
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-2348
Country	:	US
Telephone Number	:	219-895-9816
Fax Number	:

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

Provider Enumeration Date	:	08/13/2024
Last Update Date	:	08/13/2024

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Directions to “ DAMONTE LOWERY ” Practice Location

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