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General NPI Number Information
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NPI Number | 1174295067
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Entity Type | Individual
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Provider Name | VICTORIA POCKNELL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 5730 W ROOSEVELT RD
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City | CHICAGO
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State | IL
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Zip | 60644-1580
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Country | US
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Telephone | 773-413-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 21 SPINNING WHEEL RD APT 11G
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City | HINSDALE
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State | IL
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Zip | 60521-7644
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Country | US
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Telephone | 602-703-7194
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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 | 071.010625
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License Number State | IL
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