Provider Demographics
NPI:1750307914
Name:NADOR, SALLY JO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:JO
Last Name:NADOR
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 1:1622 WILMETTE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2425
Mailing Address - Country:US
Mailing Address - Phone:847-256-7215
Mailing Address - Fax:847-256-7215
Practice Address - Street 1:1622 WILMETTE AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2425
Practice Address - Country:US
Practice Address - Phone:847-256-7215
Practice Address - Fax:847-256-7215
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004129103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL924790Medicare ID - Type Unspecified