Provider Demographics
NPI:1235886425
Name:POMEROY, DIANN KAY
Entity Type:Individual
Prefix:
First Name:DIANN
Middle Name:KAY
Last Name:POMEROY
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 1:360 E SOUTH WATER ST APT 1110
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-4123
Mailing Address - Country:US
Mailing Address - Phone:847-445-8606
Mailing Address - Fax:
Practice Address - Street 1:61 S OLD RAND RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3127
Practice Address - Country:US
Practice Address - Phone:847-438-4222
Practice Address - Fax:847-438-0844
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health