| NPI | 1942648761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICKA SWANSON Owner 219-805-0451 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071007992) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IL 071008135) |
| 103TC0700X Psychologist Clinical (Licence: IL 071007988) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2022-07-12 |