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General NPI Number Information
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NPI Number | 1558883322
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Entity Type | Individual
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Provider Name | MICHELLE CHRISTINE LOZANO
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Gender | Female
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 4700 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60632-2016
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Country | US
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Telephone | 773-584-6200
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Fax | 844-285-1003
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Provider Business Mailing Address
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Address Line | 1940 S WESTERN AVENUE SUITE 205
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City | CHICAGO
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State | IL
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Zip | 60608-2503
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Country | US
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Telephone | 773-584-6200
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Fax | 844-285-1003
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166001415
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License Number State | IL
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