Provider Demographics
NPI:1326219510
Name:OAK FOREST PSYCHOLOGICAL SERVICE
Entity Type:Organization
Organization Name:OAK FOREST PSYCHOLOGICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-215-8400
Mailing Address - Street 1:6502 JOLIET RD
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4613
Mailing Address - Country:US
Mailing Address - Phone:708-215-8400
Mailing Address - Fax:708-215-8410
Practice Address - Street 1:6502 JOLIET RD
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-4682
Practice Address - Country:US
Practice Address - Phone:708-215-8400
Practice Address - Fax:708-215-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL797630Medicare PIN