| NPI | 1417643503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L CORLEY Licensed Psychologist 224-636-4942 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2023-06-07 |