Provider Demographics
NPI:1184982241
Name:LORRAINE DEUTSCH JOHNSON AU.D. PC
Entity type:Organization
Organization Name:LORRAINE DEUTSCH JOHNSON AU.D. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:DEUTSCH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:815-483-9834
Mailing Address - Street 1:1439 FECHNER CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1807
Mailing Address - Country:US
Mailing Address - Phone:815-483-9834
Mailing Address - Fax:630-907-9204
Practice Address - Street 1:1439 FECHNER CIR
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1807
Practice Address - Country:US
Practice Address - Phone:815-483-9834
Practice Address - Fax:630-907-9204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000065261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center