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General NPI Number Information
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NPI Number | 1801526561
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Entity Type | Individual
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Provider Name | LOREN PHILLIP HIZEL PHD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 1800 HOLLISTER DR STE G10
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-5264
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Country | US
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Telephone | 847-786-5366
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2257
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City | CHESTERTON
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State | IN
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Zip | 46304-0357
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Country | US
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Telephone | 219-926-8320
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Fax |
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 071010697
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License Number State | IL
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