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NPI Code Detail

MEDICARE: JAMIE TOLMATSKY PSYD

MEDICARE: JAMIE TOLMATSKY PSYD
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
1103TC0700XClinical Psychologist071010373IL

General Provider Information

NPI Number : 1801491014
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE TOLMATSKY PSYD
Provider Business Mailing Address
First Line : 1507 W LAWRENCE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4702
Country : US
Telephone Number : 773-569-1468
Fax Number :
Provider Business Practice Location Address
First Line : 1507 W LAWRENCE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4702
Country : US
Telephone Number : 847-373-2551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2020
Last Update Date : 12/03/2020

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