| NPI | 1477083392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANTA NISHI KANUKOLLU Clinical Psychologist 773-270-2360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 071.008400) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2017-06-15 |