| NPI | 1508051541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA M. NICHOLAS Clinical Psychologist 847-732-1704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071006921) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2007-09-12 |