Provider Demographics
NPI:1275664468
Name:LOWRY, LISA N (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:N
Last Name:LOWRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:N
Other - Last Name:DYHRKOPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:741 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1512
Mailing Address - Country:US
Mailing Address - Phone:708-337-0799
Mailing Address - Fax:708-445-0980
Practice Address - Street 1:741 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1512
Practice Address - Country:US
Practice Address - Phone:708-337-0799
Practice Address - Fax:708-445-0980
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623273OtherBLUE CROSS BLUE SHIELD