Healthcare Provider Details

I. General information

NPI: 1700079886
Provider Name (Legal Business Name): JOSEPH N. O'DONNELL & ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 W SCHAUMBURG RD 22E
SCHAUMBURG IL
60194-4065
US

IV. Provider business mailing address

1443 W SCHAUMBURG RD 22E
SCHAUMBURG IL
60194-4065
US

V. Phone/Fax

Practice location:
  • Phone: 847-298-6446
  • Fax: 847-298-6447
Mailing address:
  • Phone: 847-298-6446
  • Fax: 847-298-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071001830
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071001830
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number071001830
License Number StateIL

VIII. Authorized Official

Name: DR. JOSEPH N. O'DONNELL
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 847-298-6446