MEDICARE: DR. LAWRENCE TODRYK PSY.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	071006449	IL

General Provider Information

NPI Number	:	1326164377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE TODRYK PSY.D.

Provider Business Mailing Address
First Line	:	355 BELLE CT
Second Line	:
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-2301
Country	:	US
Telephone Number	:	224-577-5308
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N ATKINSON RD STE 106
Second Line	:
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-7805
Country	:	US
Telephone Number	:	224-577-5308
Fax Number	:	847-223-0911

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	03/27/2023

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