| NPI | 1326828278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKSON NEWSOME Licensed Clinical Psychologist 773-683-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2023-09-28 |
| Last Update Date | 2023-09-28 |