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General NPI Number Information
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NPI Number | 1194912824
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Entity Type | Individual
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Provider Name | DIANE PIES TOBY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 5007 LINCOLN AVE SUITE 106
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City | LISLE
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State | IL
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Zip | 60532-4187
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Country | US
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Telephone | 630-470-7921
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Fax | 630-629-8048
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Provider Business Mailing Address
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Address Line | 5007 LINCOLN AVE SUITE 106
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City | LISLE
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State | IL
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Zip | 60532-4187
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Country | US
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Telephone | 630-470-7921
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Fax | 630-629-8048
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 071.007194
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 071.007194
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License Number State | IL
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