Provider Demographics
NPI:1114245537
Name:GORCOWSKI, LYNNE MARIE
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:MARIE
Last Name:GORCOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 FOX HOUND TRL
Mailing Address - Street 2:
Mailing Address - City:BEECHER
Mailing Address - State:IL
Mailing Address - Zip Code:60401-3682
Mailing Address - Country:US
Mailing Address - Phone:708-946-6079
Mailing Address - Fax:
Practice Address - Street 1:1576 FOX HOUND TRL
Practice Address - Street 2:
Practice Address - City:BEECHER
Practice Address - State:IL
Practice Address - Zip Code:60401-3682
Practice Address - Country:US
Practice Address - Phone:708-946-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist