Healthcare Provider Details

I. General information

NPI: 1043258593
Provider Name (Legal Business Name): SPECIAL NEEDS PSYCHOLOGICAL SERVICES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 E 83RD ST
CHICAGO IL
60617-2007
US

IV. Provider business mailing address

2649 171ST ST
HAZEL CREST IL
60429-1140
US

V. Phone/Fax

Practice location:
  • Phone: 708-845-6555
  • Fax: 708-335-2049
Mailing address:
  • Phone: 708-845-6555
  • Fax: 708-335-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SHIRLEY J. GRAHAM
Title or Position: ADMINISTRATOR
Credential:
Phone: 708-845-6555