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General NPI Number Information
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NPI Number | 1205127594
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL SERVICES OF NAPERVILLE
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 445 W JACKSON AVE SUITE 204
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City | NAPERVILLE
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State | IL
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Zip | 60540-5256
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Country | US
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Telephone | 630-428-3908
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Fax | 630-428-3908
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Provider Business Mailing Address
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Address Line | 445 W JACKSON AVE SUITE 204
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City | NAPERVILLE
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State | IL
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Zip | 60540-5256
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Country | US
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Telephone | 630-428-3908
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Fax | 630-428-3908
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. KATHLEEN HICKEY
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Credential | PSY.D.
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Telephone | 630-428-3908
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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 | 71006796
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License Number State | IL
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