Provider Demographics
NPI:1083789945
Name:LULOFS, DEANNA ISABEL (PSY D)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:ISABEL
Last Name:LULOFS
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 INDIAN RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-3102
Mailing Address - Country:US
Mailing Address - Phone:847-395-9381
Mailing Address - Fax:
Practice Address - Street 1:1641 N MILWAUKEE AVE ST #7
Practice Address - Street 2:ADLER PARK PLAZA
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1350
Practice Address - Country:US
Practice Address - Phone:847-362-6919
Practice Address - Fax:847-247-2220
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical