| NPI | 1972035418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANE E. SAMUELSON Owner/Provider 708-524-1267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-003172) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2017-04-03 |