| NPI | 1114334547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE LONDON Sole Mbr 312-504-4428 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071008380) |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2014-07-22 |