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General NPI Number Information
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NPI Number | 1952504664
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Entity Type | Organization
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Legal Business Name | LYNNE M. SIMON PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 636 CHURCH ST STE 619A
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City | EVANSTON
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State | IL
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Zip | 60201-4586
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Country | US
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Telephone | 847-328-8779
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Fax |
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Provider Business Mailing Address
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Address Line | 404 CHURCH ST
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City | EVANSTON
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State | IL
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Zip | 60201-4514
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Country | US
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Telephone | 847-328-8779
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LYNNE M. SIMON
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Credential | PH.D.
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Telephone | 847-328-8779
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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 | 071003423
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License Number State | IL
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