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General NPI Number Information
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NPI Number | 1962230391
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Entity Type | Individual
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Provider Name | GARRETT WALTER SIDOR PSYD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2024
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 33 N. DEARBORN SUITE 800
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City | CHICAGO
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State | IL
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Zip | 60602
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Country | US
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Telephone | 224-223-2802
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Fax |
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Provider Business Mailing Address
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Address Line | 2135 E PEACHTREE LN
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-3433
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Country | US
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Telephone | 847-224-0081
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 071010798
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License Number State | IL
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