| NPI | 1821151135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID R. JEZL Executive Director 847-884-0210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 103G00000X Clinical Neuropsychologist | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2015-02-26 |