| NPI | 1053657825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY ANSON Practice Owner 847-791-5078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-0005222) |
| Enumeration Date | 2012-12-22 |
| Last Update Date | 2013-01-03 |