Healthcare Provider Details

I. General information

NPI: 1629543764
Provider Name (Legal Business Name): COLLEEN DEWAN M.ED.AND ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 CAINE DR
NAPERVILLE IL
60564-6124
US

IV. Provider business mailing address

3727 CAINE DR
NAPERVILLE IL
60564-6124
US

V. Phone/Fax

Practice location:
  • Phone: 630-699-5543
  • Fax:
Mailing address:
  • Phone: 630-699-5543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: