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General NPI Number Information
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NPI Number | 1740308493
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Entity Type | Organization
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Legal Business Name | PAULETTE TOBUREN
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 15010 S RAVINIA AVE SUITE 19
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City | ORLAND PARK
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State | IL
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Zip | 60462-3162
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Country | US
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Telephone | 708-403-3200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1145
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City | ORLAND PARK
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State | IL
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Zip | 60462-8145
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Country | US
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Telephone | 708-403-3200
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. ELIZABETH ZAVODNY
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Credential | PSY.D.
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Telephone | 708-403-3200
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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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