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General NPI Number Information
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NPI Number | 1124355664
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Entity Type | Organization
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Legal Business Name | NANCY LANDRE PHD, P.C.
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 2604 DEMPSTER ST SUITE 510
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City | PARK RIDGE
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State | IL
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Zip | 60068-8412
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Country | US
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Telephone | 847-291-2758
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Fax | 815-455-4322
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Provider Business Mailing Address
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Address Line | 2604 DEMPSTER ST SUITE 510
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City | PARK RIDGE
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State | IL
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Zip | 60068-8412
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Country | US
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Telephone | 847-291-2758
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Fax | 815-455-4322
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Authorized Official
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Title or Position | OWNER
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Name | DR. NANCY LANDRE
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Credential | PH.D.
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Telephone | 847-219-2758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 071004694
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License Number State | IL
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