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General NPI Number Information
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NPI Number | 1891026340
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Entity Type | Organization
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Legal Business Name | CHICAGO PSYCHOLOGIST PC
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Dates
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Enumeration Date | 01/22/2010
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Last Update Date | 01/22/2010
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Provider Practice Location Address
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Address Line | 355 W NORTHWEST HWY
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City | PALATINE
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State | IL
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Zip | 60067-2414
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Country | US
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Telephone | 773-771-6604
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Fax |
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Provider Business Mailing Address
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Address Line | 6348 N MILWAUKEE AVE #143
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City | CHICAGO
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State | IL
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Zip | 60646-3728
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. KARLA V ANDERSON
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Credential | PSYD
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Telephone | 773-771-6604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 071007182
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License Number State | IL
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