Healthcare Provider Details

I. General information

NPI: 1417127879
Provider Name (Legal Business Name): LORI EYMAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E 22ND ST STE 210
LOMBARD IL
60148-6108
US

IV. Provider business mailing address

10 E 22ND ST STE 210
LOMBARD IL
60148-6108
US

V. Phone/Fax

Practice location:
  • Phone: 630-627-5000
  • Fax: 630-627-5032
Mailing address:
  • Phone: 630-627-5000
  • Fax: 630-627-5032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.0005617
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: