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General NPI Number Information
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NPI Number | 1902138803
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Entity Type | Organization
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Legal Business Name | NAPERVILLE PEDIATRIC PSYCHOLOGY & DEVELOPMENT
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 1220 HOBSON RD SUITE 112
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City | NAPERVILLE
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State | IL
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Zip | 60540-8139
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Country | US
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Telephone | 630-548-9237
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Fax | 630-548-9366
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Provider Business Mailing Address
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Address Line | 1220 HOBSON ROAD SUITE 112
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City | NAPERVILLE
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State | IL
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Zip | 60540
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Country | US
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Telephone | 630-548-9237
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Fax | 630-548-9366
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. JENNIFER MANFRE
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Credential | PSY.D.
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Telephone | 630-548-9237
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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 | 71.007476
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License Number State | IL
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