| NPI | 1649674524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MEDINA Owner 773-339-0621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO PSY.0004192) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2015-12-07 |