| NPI | 1447575550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY BIDWELL Director 815-322-3280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.007831) |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2010-03-31 |