Healthcare Provider Details

I. General information

NPI: 1972603645
Provider Name (Legal Business Name): AOIFE LOUISE LYONS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W BELMONT AVE SUITE 302
CHICAGO IL
60657-3200
US

IV. Provider business mailing address

3129 N HONORE ST
CHICAGO IL
60657-2030
US

V. Phone/Fax

Practice location:
  • Phone: 773-244-3151
  • Fax: 773-880-1315
Mailing address:
  • Phone: 773-244-3151
  • Fax: 773-880-1315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: