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NPI Code Detail

MEDICARE: RUDOLF DREIKURS PSYCHOLOGICAL SER. CEN.

MEDICARE: RUDOLF DREIKURS PSYCHOLOGICAL SER. CEN.
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 Psychologist098.000036IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11617343OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1891816179
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUDOLF DREIKURS PSYCHOLOGICAL SER. CEN.
Provider Business Mailing Address
First Line : 65 E WACKER PL
Second Line : STE. 2100
City : CHICAGO
State : IL
Zip : 60601-7296
Country : US
Telephone Number : 312-201-5900
Fax Number : 312-201-8755
Provider Business Practice Location Address
First Line : 65 E WACKER PL
Second Line : STE. 2200
City : CHICAGO
State : IL
Zip : 60601-7296
Country : US
Telephone Number : 312-201-5900
Fax Number : 312-201-8755
Authorized Official
Title or Position : DIRECTOR OF THE DREIKURS PSC
Name : DR. DANIEL F. BARNES
Credential : PH. D.
Telephone Number : 312-201-5900
Provider Enumeration Date : 04/03/2007
Last Update Date : 08/18/2008

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