Healthcare Provider Details

I. General information

NPI: 1609086891
Provider Name (Legal Business Name): WEI-JEN W HUANG PH.D., CGP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 RIVERWOODS RD
RIVERWOODS IL
60015-1967
US

IV. Provider business mailing address

2350 RIVERWOODS RD
RIVERWOODS IL
60015-1967
US

V. Phone/Fax

Practice location:
  • Phone: 847-405-0342
  • Fax: 847-405-0342
Mailing address:
  • Phone: 847-405-0342
  • Fax: 847-405-0342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: