| NPI | 1336379304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WILLIAM ALLEN Clinical Psychologist 773-478-2982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 071-007404) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: IL 071-007404) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2009-07-23 |