Provider Demographics
NPI:1275754822
Name:MAREK-MCKILLOP, LORI ANN (MS,LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:MAREK-MCKILLOP
Suffix:
Gender:F
Credentials:MS,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E SCHILLER ST
Mailing Address - Street 2:SUITE 227
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2858
Mailing Address - Country:US
Mailing Address - Phone:708-309-0915
Mailing Address - Fax:
Practice Address - Street 1:110 E SCHILLER ST
Practice Address - Street 2:SUITE227
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2858
Practice Address - Country:US
Practice Address - Phone:708-309-0915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1891025995OtherNPI TYPE 2