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General NPI Number Information
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NPI Number | 1891984217
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Entity Type | Organization
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Legal Business Name | SYCAMORE PSYCHIATRY SC
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 2535 BETHANY RD SUITE 201B
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City | SYCAMORE
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State | IL
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Zip | 60178-3126
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Country | US
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Telephone | 815-754-7500
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Fax | 815-754-0400
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Provider Business Mailing Address
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Address Line | 2535 BETHANY RD SUITE 201B
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City | SYCAMORE
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State | IL
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Zip | 60178-3126
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Country | US
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Telephone | 815-754-7500
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Fax | 815-754-0400
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Authorized Official
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Title or Position | BILLER
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Name | MRS. CATHERINE ANN PLAUCK
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Credential |
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Telephone | 815-754-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | IL
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