MEDICARE: DR. JOAN MARIE DURLACHER 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
1	103T00000X	Psychologist		IL

General Provider Information

NPI Number	:	1851402176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAN MARIE DURLACHER PSYD

Provider Business Mailing Address
First Line	:	314 N DRYDEN PL
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6314
Country	:	US
Telephone Number	:	847-870-0011
Fax Number	:	847-870-0225

Provider Business Practice Location Address
First Line	:	314 N DRYDEN PL
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6314
Country	:	US
Telephone Number	:	847-870-0011
Fax Number	:	847-870-0225

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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