Provider Demographics
NPI:1912398942
Name:PSYCHOLOGY SPECIALISTS
Entity Type:Organization
Organization Name:PSYCHOLOGY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHWAJI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:309-706-3190
Mailing Address - Street 1:350 S NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4216
Mailing Address - Country:US
Mailing Address - Phone:309-706-3190
Mailing Address - Fax:309-588-4115
Practice Address - Street 1:350 S NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4216
Practice Address - Country:US
Practice Address - Phone:309-706-3190
Practice Address - Fax:309-588-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008742103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty