Healthcare Provider Details

I. General information

NPI: 1114153491
Provider Name (Legal Business Name): LORI S MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 FOX DR
CHAMPAIGN IL
61820-7236
US

IV. Provider business mailing address

211 PADDOCK DR E
SAVOY IL
61874-9666
US

V. Phone/Fax

Practice location:
  • Phone: 217-398-8080
  • Fax:
Mailing address:
  • Phone: 217-766-7225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: