Provider Demographics
NPI:1609003938
Name:NAPERVILLE CLINICAL SERVICES, INC,
Entity Type:Organization
Organization Name:NAPERVILLE CLINICAL SERVICES, INC,
Other - Org Name:NAPERVILLE CLINICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:PLONIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-409-9700
Mailing Address - Street 1:2272 W 95TH ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8942
Mailing Address - Country:US
Mailing Address - Phone:630-409-9700
Mailing Address - Fax:630-409-9444
Practice Address - Street 1:2272 W 95TH ST
Practice Address - Street 2:SUITE 115
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8942
Practice Address - Country:US
Practice Address - Phone:630-409-9700
Practice Address - Fax:630-409-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-13
Last Update Date:2009-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007373103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty