Healthcare Provider Details

I. General information

NPI: 1508266313
Provider Name (Legal Business Name): NATALIE A PAMPHILE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S RIVER ST
AURORA IL
60506-5185
US

IV. Provider business mailing address

2210 DEAN ST
ST CHARLES IL
60175-1066
US

V. Phone/Fax

Practice location:
  • Phone: 630-844-2662
  • Fax:
Mailing address:
  • Phone: 630-377-1695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008879
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: