Healthcare Provider Details

I. General information

NPI: 1639869688
Provider Name (Legal Business Name): VUKOTIC INTERCULTURAL PSYCHOLOGY & ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N NORTHWEST HWY STE 200
PARK RIDGE IL
60068-1459
US

IV. Provider business mailing address

714 WALNUT DR APT 110
DARIEN IL
60561-4709
US

V. Phone/Fax

Practice location:
  • Phone: 872-808-0068
  • Fax:
Mailing address:
  • Phone: 847-877-1691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. TATIANA VUKOTIC
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PSYD
Phone: 872-808-0068