| NPI | 1801993142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY WILSON Credentialing/Billing Specialist 309-692-6622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 071-004483) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-10-03 |