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General NPI Number Information
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NPI Number | 1962666362
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Entity Type | Organization
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Legal Business Name | S. C. VALESSARES, PSY.D., INC.
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 3 SQUIRE LN
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City | ST CHARLES
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State | IL
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Zip | 60174-1413
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Country | US
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Telephone | 630-881-7601
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Fax | 630-513-6839
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Provider Business Mailing Address
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Address Line | 3 SQUIRE LN
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City | ST CHARLES
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State | IL
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Zip | 60174-1413
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Country | US
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Telephone | 630-881-7601
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Fax | 630-513-6839
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN CHRISTINE VALESSARES
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Credential | PSY.D.
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Telephone | 630-881-7601
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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 | 071-006810
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 071-006810
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License Number State | IL
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