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General NPI Number Information
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NPI Number | 1871173674
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Entity Type | Organization
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Legal Business Name | B NETTLETON PSYD LLC
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE STE 1204
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City | CHICAGO
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State | IL
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Zip | 60602-3725
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Country | US
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Telephone | 312-446-5602
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 N LA SALLE DR APT 16A
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City | CHICAGO
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State | IL
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Zip | 60610-7610
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Country | US
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Telephone | 312-446-5602
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/OWNER
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Name | DR. BETSY JANE NETTLETON
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Credential | PSYD
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Telephone | 312-446-5602
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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 |
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