Healthcare Provider Details

I. General information

NPI: 1093291163
Provider Name (Legal Business Name): LORI CRAMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MAIN ST STE 210
ANTIOCH IL
60002-1578
US

IV. Provider business mailing address

PO BOX 1085
LAKE VILLA IL
60046-1085
US

V. Phone/Fax

Practice location:
  • Phone: 184-790-3560
  • Fax:
Mailing address:
  • Phone: 847-903-5604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149019958
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: