| NPI | 1437639473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN WILDT Executive Assistant 217-370-7540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 071009493) |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2018-08-20 |