| NPI | 1982100921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY WILLARD Licensed Clinical Psychologist 312-798-9078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 170.009205) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2018-03-30 |