Healthcare Provider Details

I. General information

NPI: 1154500452
Provider Name (Legal Business Name): MARY PLONIS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2272 95TH ST STE 125
NAPERVILLE IL
60564-8982
US

IV. Provider business mailing address

2272 95TH ST STE 125
NAPERVILLE IL
60564-8982
US

V. Phone/Fax

Practice location:
  • Phone: 630-409-9700
  • Fax:
Mailing address:
  • Phone: 630-409-9700
  • Fax: 630-409-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007373
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: