Provider Demographics
NPI:1619389731
Name:LORENZ, KELLY (MT-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LORENZ
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18356 MYRTLE CT
Mailing Address - Street 2:UNIT 4
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3342
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18356 MYRTLE CT
Practice Address - Street 2:UNIT 4
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3342
Practice Address - Country:US
Practice Address - Phone:219-381-5791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist