MEDICARE: DR. HELEN PUGACZ APPLETON PH.D.

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	103TC0700X	Clinical Psychologist	071002838	IL

General Provider Information

NPI Number	:	1073557609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HELEN PUGACZ APPLETON PH.D.

Provider Business Mailing Address
First Line	:	1629 S WIGGINS AVE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-3371
Country	:	US
Telephone Number	:	217-793-3949
Fax Number	:	217-793-3995

Provider Business Practice Location Address
First Line	:	SPRINGFIELD PSYCHOLOGICAL CENTER
Second Line	:	2325 WEST WHITE OAKS DRIVE, SUITE C
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-7420
Country	:	US
Telephone Number	:	217-793-3949
Fax Number	:	217-793-3995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	05/01/2008

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