Healthcare Provider Details

I. General information

NPI: 1568637874
Provider Name (Legal Business Name): CHRISTINE PARADEE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEMORIAL MEDICAL CTR 701 N. 1ST
SPRINGFIELD IL
62781-0001
US

IV. Provider business mailing address

501 N 1ST ST
SPRINGFIELD IL
62702-5115
US

V. Phone/Fax

Practice location:
  • Phone: 217-788-4180
  • Fax:
Mailing address:
  • Phone: 217-788-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071007462
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007462
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: