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General NPI Number Information
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NPI Number | 1104923408
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Entity Type | Individual
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Provider Name | MARC DRUMMOND PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 1700 N FARNSWORTH AVE SUITE 12
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City | AURORA
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State | IL
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Zip | 60505-1523
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Country | US
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Telephone | 630-851-6100
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Fax | 630-851-6154
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Provider Business Mailing Address
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Address Line | 314 FLINTLOCK CT
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City | OSWEGO
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State | IL
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Zip | 60543-8770
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Country | US
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Telephone | 630-301-0658
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180003279
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071008271
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License Number State | IL
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