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Behavioral Health & Social Service Providers Clinical Neuropsychologist

Provider NPI: 1861442345

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 630-632-0746  Fax: 847-272-8221

Business Mailing Address:
PO BOX 472  NORTHBROOK, IL 60065-0472 US
Tel: 847-504-4060  Fax: 847-919-8399

NPI Information:
NPI: 1861442345
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
Y103TC0700XBehavioral Health & Social Service Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 103TC0700X





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