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General NPI Number Information
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NPI Number | 1427501469
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Entity Type | Organization
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Legal Business Name | CHICAGO NEURODEVELOPMENTAL CENTER
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 601 SKOKIE BLVD SUITE 203
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City | NORTHBROOK
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State | IL
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Zip | 60062-2851
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Country | US
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Telephone | 847-272-2484
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Fax |
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Provider Business Mailing Address
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Address Line | 601 SKOKIE BLVD SUITE 203
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City | NORTHBROOK
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State | IL
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Zip | 60062-2851
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Country | US
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Telephone | 847-272-2484
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/CO-OWNER
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Name | ANNE HOWARD
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Credential | PH.D.
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Telephone | 847-272-2484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 071008032
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License Number State | IL
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