| NPI | 1962927624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIELLE L WOLK Provider 847-410-2029 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071009469) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2022-07-21 |