Healthcare Provider Details

I. General information

NPI: 1104043546
Provider Name (Legal Business Name): NANCY JOAN LAWRENZ PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SALT CREEK LN SUITE 316
HINSDALE IL
60521-2926
US

IV. Provider business mailing address

15 SALT CREEK LN SUITE 316
HINSDALE IL
60521-2926
US

V. Phone/Fax

Practice location:
  • Phone: 630-325-4855
  • Fax: 630-288-0075
Mailing address:
  • Phone: 630-325-4855
  • Fax: 630-288-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071004691
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: