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General NPI Number Information
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NPI Number | 1366116923
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Entity Type | Organization
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Legal Business Name | LOMBARD NEUROPSYCHOLOGICAL CENTER
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 477 E BUTTERFIELD RD STE 310
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City | LOMBARD
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State | IL
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Zip | 60148-4880
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Country | US
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Telephone | 872-228-7243
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Fax |
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Provider Business Mailing Address
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Address Line | 477 E BUTTERFIELD RD STE 310
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City | LOMBARD
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State | IL
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Zip | 60148-4880
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Country | US
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Telephone | 872-228-7243
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL PSYCHOLOGIST
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Name | DR. ANNA JASIEWICZ
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Credential | PSY.D.,QEEG-D,BCN
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Telephone | 630-589-9580
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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 |
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