Provider Demographics
NPI:1225451081
Name:WELLMAN PSYCHOLOGY & ASSOCIATES S.C.
Entity Type:Organization
Organization Name:WELLMAN PSYCHOLOGY & ASSOCIATES S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SPICHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-220-8904
Mailing Address - Street 1:3660 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3660 N LAKE SHORE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5300
Practice Address - Country:US
Practice Address - Phone:773-220-8904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008214103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty