| NPI | 1497949762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORIS M VAN BYSSUM President/Owner 630-858-0875 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.010527041.189584) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071004744) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2017-03-14 |