=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275754822
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI ANN MAREK-MCKILLOP M.S.,L.C.P.C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 02/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 E SCHILLER ST SUITE227
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-2858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-309-0915
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 E SCHILLER ST SUITE 227
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-2858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-309-0915
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180.006796
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------