| NPI | 1760656581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS J NISWONGER Owner 708-364-3232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-007045) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2010-02-18 |