| NPI | 1184863847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY M WAHLBERG Office Manager 630-845-9644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071006627) |
| Enumeration Date | 2009-02-19 |
| Last Update Date | 2009-02-19 |