Provider Demographics
NPI:1235234907
Name:DEYOUNG, LORI ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W NORTH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-5730
Mailing Address - Country:US
Mailing Address - Phone:217-497-7484
Mailing Address - Fax:
Practice Address - Street 1:101 W NORTH ST FL 3
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5730
Practice Address - Country:US
Practice Address - Phone:217-497-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0088091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09232024OtherBLUE CROSS BLUE SHIELD