| NPI | 1407243918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLA LYDIA WIEGAND CEO 847-313-0977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.006380) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2015-04-22 |