Provider Demographics
NPI:1972526796
Name:VANDERBOSCH, JAMES EDWARD JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:VANDERBOSCH
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
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Mailing Address - Street 1:800 E NORTHWEST HWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3457
Mailing Address - Country:US
Mailing Address - Phone:847-909-9858
Mailing Address - Fax:847-299-4952
Practice Address - Street 1:800 E NORTHWEST HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3457
Practice Address - Country:US
Practice Address - Phone:847-909-9858
Practice Address - Fax:847-299-4952
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL071-004671103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical