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General NPI Number Information
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NPI Number | 1437283140
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Entity Type | Organization
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Legal Business Name | BURTON SIEGEL PHD.LTD
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 501 W OGDEN AVE SUITE 6
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City | HINSDALE
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State | IL
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Zip | 60521-3179
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Country | US
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Telephone | 630-920-0900
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Fax | 630-920-0931
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Provider Business Mailing Address
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Address Line | 501 W OGDEN AVE SUITE 6
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City | HINSDALE
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State | IL
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Zip | 60521-3179
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Country | US
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Telephone | 630-920-0900
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Fax | 630-920-0931
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Authorized Official
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Title or Position | OWNER
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Name | DR. BURTON SIEGEL
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Credential | PH.D
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Telephone | 630-920-0900
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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 | 071000293
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License Number State | IL
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