MEDICARE: JOANNE MARIE LORENZ 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	071003693	IL

General Provider Information

NPI Number	:	1497725394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE MARIE LORENZ PH.D.

Provider Business Mailing Address
First Line	:	1112 S WASHINGTON ST
Second Line	:	SUITE 217
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-7959
Country	:	US
Telephone Number	:	630-355-4070
Fax Number	:	630-629-8048

Provider Business Practice Location Address
First Line	:	1112 S WASHINGTON ST
Second Line	:	SUITE 217
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-7959
Country	:	US
Telephone Number	:	630-355-4070
Fax Number	:	630-629-8048

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/29/2010

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