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General NPI Number Information
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NPI Number | 1033735550
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Entity Type | Organization
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Legal Business Name | SPRINGSOURCE PSYCHOLOGICAL CENTER, PLLC
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Dates
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Enumeration Date | 06/20/2020
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 53 W JACKSON BLVD STE 520
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City | CHICAGO
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State | IL
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Zip | 60604-3433
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Country | US
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Telephone | 224-202-6260
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Fax |
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Provider Business Mailing Address
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Address Line | 1770 HARRISON ST
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City | GLENVIEW
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State | IL
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Zip | 60025-5065
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | SUSAN FOTI MCCLANAHAN
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Credential | PH.D.
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Telephone | 312-337-6064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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