Provider Demographics
NPI:1962822346
Name:PANOZZO THERAPY, INC
Entity Type:Organization
Organization Name:PANOZZO THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PANOZZO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-846-2869
Mailing Address - Street 1:PO BOX 2351
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1030
Mailing Address - Country:US
Mailing Address - Phone:708-846-2869
Mailing Address - Fax:708-349-1464
Practice Address - Street 1:15915 S CRYSTAL CREEK DR
Practice Address - Street 2:UNIT E
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-9284
Practice Address - Country:US
Practice Address - Phone:708-846-2869
Practice Address - Fax:708-349-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.012262251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216914OtherPTAN