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General NPI Number Information
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NPI Number | 1174554331
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF ILLINOIS - CHICAGO
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 1640 W ROOSEVELT RD ROOM 336 (MC 628)
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City | CHICAGO
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State | IL
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Zip | 60608-1316
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Country | US
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Telephone | 312-413-1567
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Fax | 312-413-1993
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Provider Business Mailing Address
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Address Line | 5254 SOLUTION CENTER
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City | CHICAGO
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State | IL
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Zip | 60677-0001
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Country | US
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Telephone | 312-413-1567
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Fax | 312-413-1993
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BO L. FERNHALL
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Credential | PHD
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Telephone | 312-413-1567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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