| NPI | 1619203346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY M HIRD Clinical Psychologist 815-768-9688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071007734) |
| Enumeration Date | 2009-10-31 |
| Last Update Date | 2009-10-31 |