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General NPI Number Information
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NPI Number | 1154620052
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Entity Type | Organization
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Legal Business Name | SHEILA CULKIN, INC
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Dates
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Enumeration Date | 03/18/2011
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 636 CHURCH ST SUITE 405
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City | EVANSTON
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State | IL
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Zip | 60201-4508
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Country | US
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Telephone | 847-328-3120
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Fax |
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Provider Business Mailing Address
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Address Line | 1912 LINCOLN ST
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City | EVANSTON
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State | IL
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Zip | 60201-2206
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Country | US
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Telephone | 847-328-3120
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Fax | 847-869-2823
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHEILA MARY CULKIN
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Credential | PHD
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Telephone | 847-328-3120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071004669
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License Number State | IL
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