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General NPI Number Information
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NPI Number | 1841625563
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Entity Type | Organization
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Legal Business Name | JENA H. STALLINGS, PH.D., LLC
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Dates
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Enumeration Date | 09/12/2013
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 3166 N LINCOLN AVE SUITE 217
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City | CHICAGO
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State | IL
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Zip | 60657-3133
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Country | US
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Telephone | 773-349-2429
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Fax |
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Provider Business Mailing Address
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Address Line | 3166 N LINCOLN AVE SUITE 217
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City | CHICAGO
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State | IL
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Zip | 60657-3133
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Country | US
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Telephone | 773-349-2429
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. JENA H. STALLINGS
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Credential | PH.D.
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Telephone | 773-349-2429
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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 | 071.007989
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License Number State | IL
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