Healthcare Provider Details

I. General information

NPI: 1003206830
Provider Name (Legal Business Name): CASEY E NOREIKA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 W NORTH AVE SUITE 303-A
MELROSE PARK IL
60160-1422
US

IV. Provider business mailing address

1440 W NORTH AVE SUITE 303-A
MELROSE PARK IL
60160-1422
US

V. Phone/Fax

Practice location:
  • Phone: 877-807-5120
  • Fax: 708-460-4275
Mailing address:
  • Phone: 877-807-5120
  • Fax: 708-460-4275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071009026
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: