Provider Demographics
NPI:1932613460
Name:NORTHAGE-ORR, ALTHEA M (MA, AHG, LAC, CST)
Entity Type:Individual
Prefix:
First Name:ALTHEA
Middle Name:M
Last Name:NORTHAGE-ORR
Suffix:
Gender:F
Credentials:MA, AHG, LAC, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1214
Mailing Address - Country:US
Mailing Address - Phone:773-764-0960
Mailing Address - Fax:
Practice Address - Street 1:1622 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1214
Practice Address - Country:US
Practice Address - Phone:773-764-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000302171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist