Healthcare Provider Details

I. General information

NPI: 1205055217
Provider Name (Legal Business Name): SCOTT A. DOLLINGER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 S HIGHLAND AVE SUITE 300
LOMBARD IL
60148-4988
US

IV. Provider business mailing address

1920 S HIGHLAND AVE SUITE 300
LOMBARD IL
60148-4988
US

V. Phone/Fax

Practice location:
  • Phone: 630-792-1343
  • Fax: 630-576-5553
Mailing address:
  • Phone: 630-792-1343
  • Fax: 630-576-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071.055689
License Number StateIL

VIII. Authorized Official

Name: DR. SCOTT A DOLLINGER
Title or Position: C.E.O. - CLINICAL DIRECTOR
Credential: PSY.D.
Phone: 630-709-3526