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General NPI Number Information
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NPI Number | 1518258904
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Entity Type | Organization
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Legal Business Name | RENEE A MCARDLE PSY D & REV FRANK S MOYER P C
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 4873 MANHATTAN DR 4873 MANHATTAN DRIVE
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City | ROCKFORD
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State | IL
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Zip | 61108-2265
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Country | US
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Telephone | 815-509-6445
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Fax | 815-965-9574
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Provider Business Mailing Address
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Address Line | 4873 MANHATTAN DR 4873 MANHATTAN DRIVE
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City | ROCKFORD
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State | IL
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Zip | 61108-2265
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Country | US
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Telephone | 815-509-6445
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Fax | 815-965-9574
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | MRS. RENEE A MCARDLE
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Credential | PSY. D.
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Telephone | 815-965-1817
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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 | 071005330
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License Number State | IL
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