| NPI | 1053673988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA C. LAVIGNE Director 815-344-1999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071008295) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IL 071008295) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2024-06-18 |