| NPI | 1710611868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA TYLICKI Owner 219-743-3266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2022-07-14 |