| NPI | 1679090997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF DAUGHERTY Executive Director 618-355-4719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: IL 394137) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2022-07-21 |