Provider Demographics
NPI:1003038704
Name:SEVERANCE, MARGARET AHUVAH (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:AHUVAH
Last Name:SEVERANCE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:655 ROCKLAND RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1782
Mailing Address - Country:US
Mailing Address - Phone:847-735-1888
Mailing Address - Fax:847-234-1792
Practice Address - Street 1:655 ROCKLAND RD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1782
Practice Address - Country:US
Practice Address - Phone:847-735-1888
Practice Address - Fax:847-234-1792
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist