Provider Demographics
NPI:1598279234
Name:VILLARREAL, PATRICIA (PSYD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 N NORTHWEST HWY STE 250
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3276
Mailing Address - Country:US
Mailing Address - Phone:773-796-7035
Mailing Address - Fax:
Practice Address - Street 1:444 N NORTHWEST HWY STE 250
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3276
Practice Address - Country:US
Practice Address - Phone:773-796-7035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009614103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical