MEDICARE: SIRONA CENTER, LLC

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

General Provider Information

NPI Number	:	1659830909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIRONA CENTER, LLC

Provider Business Mailing Address
First Line	:	2005 BLOOMINGDALE RD STE B
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-2151
Country	:	US
Telephone Number	:	630-383-7222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 BLOOMINGDALE RD STE B
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-2151
Country	:	US
Telephone Number	:	630-383-7222
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KRISTEN M NEWBERRY
Credential	:	PSY.D.
Telephone Number	:	630-383-7222

Provider Enumeration Date	:	03/17/2019
Last Update Date	:	06/15/2022

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