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General NPI Number Information
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NPI Number | 1609003938
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Entity Type | Organization
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Legal Business Name | NAPERVILLE CLINICAL SERVICES, INC,
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Dates
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Enumeration Date | 06/13/2009
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Last Update Date | 06/13/2009
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Provider Practice Location Address
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Address Line | 2272 W 95TH ST SUITE 115
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City | NAPERVILLE
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State | IL
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Zip | 60564-8942
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Country | US
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Telephone | 630-409-9700
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Fax | 630-409-9444
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Provider Business Mailing Address
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Address Line | 2272 W 95TH ST SUITE 115
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City | NAPERVILLE
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State | IL
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Zip | 60564-8942
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Country | US
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Telephone | 630-409-9700
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Fax | 630-409-9444
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY T PLONIS
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Credential | PSY.D.
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Telephone | 630-409-9700
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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 | 071007373
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License Number State | IL
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