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General NPI Number Information
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NPI Number | 1902964695
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Entity Type | Organization
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Legal Business Name | LEADING CHANGE PC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7250 COLLEGE DRIVE SUITE 1W
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463
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Country | US
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Telephone | 630-247-5597
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Fax | 630-734-0359
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Provider Business Mailing Address
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Address Line | 645 JUSTINA ST
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City | HINSDALE
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State | IL
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Zip | 60521
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Country | US
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Telephone | 630-247-5597
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Fax | 630-734-0359
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. NANCY L NELSON
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Credential | PSYD
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Telephone | 630-247-5597
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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 | IL
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