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General NPI Number Information
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NPI Number | 1699812347
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Entity Type | Individual
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Provider Name | NANCY MACHONKIN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 210 N MAIN ST
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City | WHEATON
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State | IL
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Zip | 60187-5358
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Country | US
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Telephone | 630-752-9725
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 239
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City | WINFIELD
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State | IL
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Zip | 60190-0239
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Country | US
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Telephone | 630-752-9725
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State | IL
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