Provider Demographics
NPI:1043258593
Name:SPECIAL NEEDS PSYCHOLOGICAL SERVICES,INC.
Entity Type:Organization
Organization Name:SPECIAL NEEDS PSYCHOLOGICAL SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-845-6555
Mailing Address - Street 1:2649 171ST ST
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1140
Mailing Address - Country:US
Mailing Address - Phone:708-845-6555
Mailing Address - Fax:708-335-2049
Practice Address - Street 1:2705 E 83RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2007
Practice Address - Country:US
Practice Address - Phone:708-845-6555
Practice Address - Fax:708-335-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209397Medicare ID - Type Unspecified