| NPI | 1760668727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA BOMBARD Billing Manager 630-897-6851 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071006678) |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2008-04-01 |