| NPI | 1043504657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY LEANDRA RAY Licensed Clinical Psychologist 815-553-0788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 071005955) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2011-06-01 |