| NPI | 1013030725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN A BONG Licensed Clinical Psychologist/Memb 815-231-1280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TC0700X Psychologist Clinical | |
| 103G00000X Clinical Neuropsychologist | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2008-02-05 |