| NPI | 1174749881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA FISHER PAONI Partner 217-793-3949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071006429) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071003515) |
| 103TC0700X Psychologist, Clinical (Licence: IL 071002838) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 071005516) | |
| 1041C0700X Social Worker, Clinical (Licence: IL 149008476) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2017-01-12 |