Provider Demographics
NPI:1013030980
Name:WEXLER, LARRY S (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:S
Last Name:WEXLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8438 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2715
Mailing Address - Country:US
Mailing Address - Phone:847-942-6612
Mailing Address - Fax:847-675-6684
Practice Address - Street 1:1550 SPRING RD
Practice Address - Street 2:STE. 215
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1320
Practice Address - Country:US
Practice Address - Phone:630-833-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1673382OtherBLUE SHIELD
IL931800Medicare ID - Type Unspecified
ILR18409Medicare UPIN