Provider Demographics
NPI:1124593793
Name:LOWE, EMILY A
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:LOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 SUNNYMEADE TRL
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2354
Mailing Address - Country:US
Mailing Address - Phone:815-275-6191
Mailing Address - Fax:
Practice Address - Street 1:1030 SUNNYMEADE TRL
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2354
Practice Address - Country:US
Practice Address - Phone:815-275-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-18-67565106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician