Provider Demographics
NPI:1174720452
Name:SKOWRON, LISA MARIE (MAMS, BCO, BADO, CCA)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:MARIE
Last Name:SKOWRON
Suffix:
Gender:F
Credentials:MAMS, BCO, BADO, CCA
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:SKOWRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAMS, BCO, BADO, CCA
Mailing Address - Street 1:23605 N HIGH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-9048
Mailing Address - Country:US
Mailing Address - Phone:847-719-2984
Mailing Address - Fax:847-719-2984
Practice Address - Street 1:23605 N HIGH RIDGE DR
Practice Address - Street 2:CHRYSALIS ANAPLASTOLOGY INC
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-9048
Practice Address - Country:US
Practice Address - Phone:847-719-2984
Practice Address - Fax:847-719-2984
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL33085536OtherSTATE TAX ID NUMBER