Healthcare Provider Details

I. General information

NPI: 1417010687
Provider Name (Legal Business Name): TODD RUSSELL LENDVAY PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 W COLONIAL PKWY
INVERNESS IL
60067-1207
US

IV. Provider business mailing address

26112 W INDIAN TRAIL ROAD
BARRINGTON IL
60010
US

V. Phone/Fax

Practice location:
  • Phone: 847-997-2037
  • Fax: 847-776-4724
Mailing address:
  • Phone: 847-997-2037
  • Fax: 847-776-4724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-07171
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180002906
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: