Basic Information
| Provider Information | |||||||||
| NPI: | 1104580091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOWERY | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | DILL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 N HOLLYWOOD WAY STE 102 | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915055031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667278274 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4921 N GLEN PARK PLACE RD | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616144676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8442631613 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2021 | ||||||||
| LastUpdateDate: | 12/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.