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General NPI Number Information
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NPI Number | 1245265016
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Entity Type | Individual
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Provider Name | DORALEE GRINDLER KATONAH PSY.D., M.DIV.
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Gender | Female
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1775 BALLARD RD
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City | PARK RIDGE
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State | IL
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Zip | 60068-1005
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Country | US
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Telephone | 948-318-2860
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Fax | 947-318-2922
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Provider Business Mailing Address
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Address Line | 1775 BALLARD RD
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City | PARK RIDGE
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State | IL
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Zip | 60068-1005
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Country | US
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Telephone | 948-318-2860
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Fax | 947-318-2922
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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 |
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License Number State | IL
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