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General NPI Number Information
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NPI Number | 1528357415
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Entity Type | Organization
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Legal Business Name | JAMES R IBERG
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 180 N MICHIGAN AVE SUITE 2404
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City | CHICAGO
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State | IL
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Zip | 60601-7401
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Country | US
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Telephone | 847-864-0303
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Fax |
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Provider Business Mailing Address
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Address Line | 2009 MCDANIEL AVE
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City | EVANSTON
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State | IL
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Zip | 60201-2124
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Country | US
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Telephone | 847-864-0303
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Fax | 847-475-5111
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JAMES R IBERG
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Credential | PHD
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Telephone | 847-864-0303
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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 | 071.002641
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License Number State | IL
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