MEDICARE: DR. JAMES EDWARD VANDERBOSCH JR. PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071-004671	IL

General Provider Information

NPI Number	:	1972526796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES EDWARD VANDERBOSCH JR. PSY.D.

Provider Business Mailing Address
First Line	:	800 E NORTHWEST HWY
Second Line	:	SUITE 106
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-3457
Country	:	US
Telephone Number	:	847-909-9858
Fax Number	:	847-299-4952

Provider Business Practice Location Address
First Line	:	800 E NORTHWEST HWY
Second Line	:	SUITE 106
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-3457
Country	:	US
Telephone Number	:	847-909-9858
Fax Number	:	847-299-4952

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	11/30/2015

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