| NPI | 1316959711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY A SCHUTH Practice Manager 815-455-0590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 071004798) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149003539) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2008-09-22 |