Healthcare Provider Details

I. General information

NPI: 1245384171
Provider Name (Legal Business Name): MS. LORA ANN PACIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 BURLINGTON AVE
WESTERN SPRINGS IL
60558
US

IV. Provider business mailing address

2011 72ND CT
ELMWOOD PARK IL
60707
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-0826
  • Fax: 708-354-0867
Mailing address:
  • Phone: 708-452-1802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: