Provider Demographics
NPI:1609997964
Name:LORENZ, SUSAN (DT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:LORENZ
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N LA SALLE DR
Mailing Address - Street 2:#1903
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-8539
Mailing Address - Country:US
Mailing Address - Phone:773-391-2377
Mailing Address - Fax:312-276-8377
Practice Address - Street 1:7217 W IBSEN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1102
Practice Address - Country:US
Practice Address - Phone:773-391-2377
Practice Address - Fax:773-631-4643
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist