Provider Demographics
NPI:1063490795
Name:SELINGER, STANLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
Last Name:SELINGER
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:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-0305
Mailing Address - Country:US
Mailing Address - Phone:708-798-2442
Mailing Address - Fax:708-206-1399
Practice Address - Street 1:3235 VOLLMER RD
Practice Address - Street 2:SUITE 137
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2013
Practice Address - Country:US
Practice Address - Phone:708-798-2442
Practice Address - Fax:708-206-1399
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
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
IL746730Medicare ID - Type Unspecified