1508255118 NPI number — LAUREN ELIZABETH BRYL MS, LCGC

Table of content: LAUREN ELIZABETH BRYL MS, LCGC (NPI 1508255118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508255118 NPI number — LAUREN ELIZABETH BRYL MS, LCGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYL
Provider First Name:
LAUREN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LCGC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508255118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
680 N LAKE SHORE DR STE 1230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-4411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-981-4400
Provider Business Mailing Address Fax Number:
312-981-4404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 N LAKE SHORE DR
Provider Second Line Business Practice Location Address:
SUITE 1230
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-4546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-981-4400
Provider Business Practice Location Address Fax Number:
312-981-4404
Provider Enumeration Date:
01/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X , with the licence number:  246000131 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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