Provider Demographics
NPI:1023268737
Name:MCILROY, LORI B (LCSW, CSAC)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:B
Last Name:MCILROY
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:B
Other - Last Name:WIDRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CSAC
Mailing Address - Street 1:514 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3632
Mailing Address - Country:US
Mailing Address - Phone:262-548-7666
Mailing Address - Fax:262-548-7656
Practice Address - Street 1:500 RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3632
Practice Address - Country:US
Practice Address - Phone:262-548-7655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127337104100000X
WI15435-131101YA0400X
WI7943-123104100000X
WI15406-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)