| NPI | 1588049274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON SORIANO Licensed Clinical Psychologist 815-520-0927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 071009069) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2023-01-04 |