| NPI | 1902319916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYMBERLY FAY LARSON President 630-474-4353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071008752) |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2017-11-13 |