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 |