| NPI | 1396996971 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE J FYANS Officer 217-793-8900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-002360) |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2008-10-01 |