is a Psychologist in Chicago, Illinois. practices all healthcare services and medical treatments related to Psychologist. The NPI Number for is 1689724890. The last update date is .
's current location address is 2245 W Winnemac Ave, Chicago, Illinois. You can contact this provider via phone number 7735619773 and fax number 7735619266. The mailing address for is 2245 W Winnemac Ave, Chicago, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 2245 W Winnemac Ave, Chicago, Illinois |
| Phone Number | 7735619773 |
| Fax Number | 7735619266 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1689724890 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 2245 W Winnemac Ave |
|---|---|
| City | Chicago |
| State | Illinois (IL) |
| Post Code | 606251815 |
| Phone Number | 7735619773 |
| Fax Number | 7735619266 |
Provider's Primary Taxonomy Detail
| Speciality | Psychologist |
|---|---|
| Taxonomy | 103T00000X |
| Licence No | 20040333 |
|
Definition: A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and proce |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 31604340 | IL | BCBS OF IL | |
| 17597 | VALUE OPTIONS |
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