Healthcare Provider Details

I. General information

NPI: 1285468157
Provider Name (Legal Business Name): NORMAN L BERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 W LAKE COOK RD STE 210
BUFFALO GROVE IL
60089-1975
US

IV. Provider business mailing address

2136 WESTERN AVE
WAUKEGAN IL
60087-3905
US

V. Phone/Fax

Practice location:
  • Phone: 847-393-0662
  • Fax:
Mailing address:
  • Phone: 224-321-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: