=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629454921
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNEMARIE SLOBIG, PSYD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2015
-----------------------------------------------------
Last Update Date | 08/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 137 N OAK PARK AVE 400
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60301-1344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-508-5091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 S ELMWOOD AVE
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60302-2918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-508-5091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANNEMARIE SLOBIG
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 708-508-5091
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 071-005236
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------