Provider Demographics
NPI:1427284660
Name:JOHNSON, LORRAINE DEUTSCH (AUD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:DEUTSCH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000065231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
003232001OtherBCBS PROVIDER #
ILP43760Medicare UPIN
IL998510Medicare PIN