MEDICARE: DAMON LORENZ

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	103TS0200X	School Psychologist	4399230	AZ

General Provider Information

NPI Number	:	1396024543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMON LORENZ

Provider Business Mailing Address
First Line	:	21180 N 87TH AVE
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-6497
Country	:	US
Telephone Number	:	623-412-5225
Fax Number	:	623-412-5232

Provider Business Practice Location Address
First Line	:	21180 N 87TH AVE
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-6497
Country	:	US
Telephone Number	:	623-412-5225
Fax Number	:	623-412-5232

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

Provider Enumeration Date	:	08/05/2011
Last Update Date	:	08/05/2011

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Directions to “ DAMON LORENZ ” Practice Location

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