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General NPI Number Information
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NPI Number | 1447547211
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Entity Type | Organization
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Legal Business Name | NORTHSHORE INTEGRATIVE HEALTHCARE
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 455 S ROSELLE RD SUITE 104
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City | SCHAUMBURG
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State | IL
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Zip | 60193-2971
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Country | US
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Telephone | 847-920-4644
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1592
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City | DEERFIELD
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State | IL
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Zip | 60015-6009
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Country | US
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Telephone | 847-920-4644
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH LOFLAND
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Credential |
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Telephone | 847-920-4644
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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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