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General NPI Number Information
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NPI Number | 1790968873
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Entity Type | Organization
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Legal Business Name | DR. GAIL PETRICH, ATTORNEY AND PSYCHOLOGIST, LLC
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 1801 N MILL ST STE D
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City | NAPERVILLE
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State | IL
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Zip | 60563-4869
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Country | US
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Telephone | 708-524-0171
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Fax | 708-524-4699
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Provider Business Mailing Address
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Address Line | 1801 N MILL ST STE D
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City | NAPERVILLE
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State | IL
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Zip | 60563-4869
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Country | US
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Telephone | 708-524-0171
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Fax | 708-524-4699
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GAIL PETRICH
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Credential | PSYD
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Telephone | 708-524-0171
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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 | 071006029
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License Number State | IL
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