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NPI Code Detail

MEDICARE: DR. LISA CALLIO KONICK PHD

MEDICARE: DR. LISA CALLIO KONICK PHD
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
1103TB0200XCognitive & Behavioral Psychologist07008083IL
2103TC2200XClinical Child & Adolescent Psychologist071008083IL
3103TC0700XClinical Psychologist071008083IL

General Provider Information

NPI Number : 1548548092
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA CALLIO KONICK PHD
Provider Business Mailing Address
First Line : 600 S WASHINGTON ST STE 105
Second Line :
City : NAPERVILLE
State : IL
Zip : 60540-6665
Country : US
Telephone Number : 630-206-4060
Fax Number : 855-871-8351
Provider Business Practice Location Address
First Line : 600 S WASHINGTON ST STE 105
Second Line :
City : NAPERVILLE
State : IL
Zip : 60540-6665
Country : US
Telephone Number : 630-206-4060
Fax Number : 855-871-8351
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2011
Last Update Date : 12/30/2022

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