| NPI | 1295073369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON K. NISIUS Owner 224-251-0084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.004241) |
| Enumeration Date | 2013-01-24 |
| Last Update Date | 2013-01-24 |