| NPI | 1225230378 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISA MATTESON MUNDT Manager 312-540-8977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.007178) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2011-04-01 |