| NPI | 1174837017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY FREEZE Practice Consultant 219-926-8320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IL 071007105) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2015-04-21 |