| NPI | 1174267421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE JONAS Clinical Psychologist 224-307-4074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2022-04-22 |