| NPI | 1902203631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY L KELLER Psychologist 773-931-6430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071007170) |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2014-11-24 |