MEDICARE: JOSEPH N. O'DONNELL & ASSOCIATES INC

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	071001830	IL
2	103TR0400X	Rehabilitation Psychologist	071001830	IL
3	103G00000X	Clinical Neuropsychologist	071001830	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001673146	OTHER	IL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1700079886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH N. O'DONNELL & ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1443 W SCHAUMBURG RD
Second Line	:	22E
City	:	SCHAUMBURG
State	:	IL
Zip	:	60194-4065
Country	:	US
Telephone Number	:	847-298-6446
Fax Number	:	847-298-6447

Provider Business Practice Location Address
First Line	:	1443 W SCHAUMBURG RD
Second Line	:	22E
City	:	SCHAUMBURG
State	:	IL
Zip	:	60194-4065
Country	:	US
Telephone Number	:	847-298-6446
Fax Number	:	847-298-6447

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH N. O'DONNELL
Credential	:	PH.D.
Telephone Number	:	847-298-6446

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	03/18/2009

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