| NPI | 1992036545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN H DOMANN Clinical Psychologist 773-574-4713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 3981) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071006204) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209005463041233170) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP3318) | |
| Enumeration Date | 2010-01-21 |
| Last Update Date | 2024-03-14 |