Provider Demographics
NPI:1669643003
Name:OAK FOREST PSYCHOLOGICAL SERVICE, P.C.
Entity Type:Organization
Organization Name:OAK FOREST PSYCHOLOGICAL SERVICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMIRA
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:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4682
Mailing Address - Country:US
Mailing Address - Phone:708-215-8400
Mailing Address - Fax:708-215-8410
Practice Address - Street 1:133 MOHAWK DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1349
Practice Address - Country:US
Practice Address - Phone:815-937-4790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAK FOREST PSYCHOLOGICAL SERVICE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL797500Medicare PIN