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General NPI Number Information
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NPI Number | 1104990043
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Entity Type | Individual
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Provider Name | RUTH BOUTIN KUNCEL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 911 N ELM ST SUITE 320
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City | HINSDALE
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State | IL
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Zip | 60521-3634
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Country | US
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Telephone | 630-325-4310
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Fax | 630-617-5751
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Provider Business Mailing Address
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Address Line | 911 N ELM ST SUITE 320
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City | HINSDALE
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State | IL
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Zip | 60521-3634
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Country | US
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Telephone | 630-325-4310
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Fax | 630-617-5751
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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 | 071-002327
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License Number State | IL
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