MEDICARE: JOAN DURLACHER, PSY.D., LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	060006878	IL

General Provider Information

NPI Number	:	1043533839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOAN DURLACHER, PSY.D., LTD.

Provider Business Mailing Address
First Line	:	314 N DRYDEN PL
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6314
Country	:	US
Telephone Number	:	847-870-0011
Fax Number	:	847-870-0225

Provider Business Practice Location Address
First Line	:	314 N DRYDEN PL
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6314
Country	:	US
Telephone Number	:	847-870-0011
Fax Number	:	847-870-0225

Authorized Official
Title or Position	:	PRESIDENT / CLINICAL PSYCHOLOGIST
Name	:	DR. JOAN MARIE DURLACHER
Credential	:	PSYD
Telephone Number	:	847-870-0011

Provider Enumeration Date	:	03/08/2010
Last Update Date	:	03/08/2010

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