MEDICARE: DR. LORI NINETTE OSBORNE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071.006934	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LO55330502P	OTHER	IL	EARLY INTERVENTION

General Provider Information

NPI Number	:	1275667032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI NINETTE OSBORNE PH.D.

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3040 N WILTON AVE FL 2
Second Line	:	ADVOCATE IL MASONIC PEDIATRIC DEVELOPMENTAL CENTER
City	:	CHICAGO
State	:	IL
Zip	:	60657-4424
Country	:	US
Telephone Number	:	773-296-7688
Fax Number	:	773-296-7281

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	12/01/2022

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