| NPI | 1104159631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA M KOLTUN Owner 847-669-8580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 071-07480) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: IL 071-07480) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071-07480) | |
| 103TF0000X Psychologist, Family (Licence: IL 071-07480) | |
| 103TH0004X Psychologist, Health (Licence: IL 071-07480) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IL 071-07480) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: IL 071-07480) | |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2009-09-16 |