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General NPI Number Information
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NPI Number | 1861506248
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Entity Type | Individual
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Provider Name | WILLIAM JEFFREY CANAR PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | HINES VA, SCI CENTER, BLDG 128 HINES VA, SCI CENTER, BLDG 128
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City | HINES
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State | IL
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Zip | 60141-5000
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Country | US
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Telephone | 708-202-7415
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Fax |
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Provider Business Mailing Address
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Address Line | HINES VA, SCI CENTER, BLDG 128
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City | HINES
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State | IL
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Zip | 60141-5000
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Country | US
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Telephone | 708-202-7415
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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 | 71006618
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License Number State | IL
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