Healthcare Provider Details

I. General information

NPI: 1649931445
Provider Name (Legal Business Name): SRODULSKI PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 ALGONQUIN RD STE 450
ROLLING MEADOWS IL
60008-3108
US

IV. Provider business mailing address

3035 WESLEY AVE
BERWYN IL
60402-3136
US

V. Phone/Fax

Practice location:
  • Phone: 847-502-7607
  • Fax:
Mailing address:
  • Phone: 847-502-7607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANN SRODULSKI
Title or Position: CLINICAL PSYCHOLOGIST/OWNER
Credential: PSYD
Phone: 847-502-7607