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General NPI Number Information
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NPI Number | 1104047836
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Entity Type | Individual
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Provider Name | MARY ENGLUND PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 378 COLONIAL CIR
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City | GENEVA
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State | IL
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Zip | 60134-3639
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Country | US
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Telephone | 630-639-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 25 N RIVER LN STE 25485
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City | GENEVA
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State | IL
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Zip | 60134-2263
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Country | US
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Telephone | 630-639-2777
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 071006919
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License Number State | IL
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