Healthcare Provider Details

I. General information

NPI: 1578568622
Provider Name (Legal Business Name): PAUL DALE LINDEN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N WABASH AVE STE 1408
CHICAGO IL
60602-3075
US

IV. Provider business mailing address

111 N WABASH AVE STE 1408
CHICAGO IL
60602-3075
US

V. Phone/Fax

Practice location:
  • Phone: 312-499-6873
  • Fax: 312-443-1307
Mailing address:
  • Phone: 312-499-6873
  • Fax: 312-443-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-004780
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: