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General NPI Number Information
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NPI Number | 1639743362
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Entity Type | Organization
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Legal Business Name | ADLERIAN WELLNESS CENTER, LTD
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 1595 WELD RD STE 5
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City | ELGIN
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State | IL
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Zip | 60123-5896
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Country | US
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Telephone | 224-605-5670
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5903
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City | ELGIN
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State | IL
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Zip | 60121-5903
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Country | US
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Telephone | 224-605-5670
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST-PRESIDENT
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Name | NICHOLAS FREDRICK
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Credential | PSY D
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Telephone | 224-605-5670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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