Healthcare Provider Details

I. General information

NPI: 1891837514
Provider Name (Legal Business Name): DR. JOSEPH NEIL O'DONNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 W. SCHAUMBURG ROAD 22E
SCHAUMBURG IL
60194
US

IV. Provider business mailing address

304 S. WA PELLA AVE
MOUNT PROSPECT IL
60056
US

V. Phone/Fax

Practice location:
  • Phone: 847-891-9190
  • Fax:
Mailing address:
  • Phone: 847-394-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071-001830
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-001830
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number071-001830
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: