| NPI | 1992836563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENNETT THOMAS ALLEN Clinical Psychologist 847-205-9605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071005914) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2007-10-18 |