| NPI | 1528703014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAUDETTE M JACKSON President/Clinical Psychologist 312-375-5621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2022-05-25 |