Healthcare Provider Details

I. General information

NPI: 1669643003
Provider Name (Legal Business Name): OAK FOREST PSYCHOLOGICAL SERVICE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 MOHAWK DR
BOURBONNAIS IL
60914-1349
US

IV. Provider business mailing address

6502 JOLIET RD
COUNTRYSIDE IL
60525-4682
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-4790
  • Fax:
Mailing address:
  • Phone: 708-215-8400
  • Fax: 708-215-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAMIRA SWEIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 708-215-8400