Provider Demographics
NPI:1184258808
Name:CLEMINSON PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:CLEMINSON PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-343-3432
Mailing Address - Street 1:155 N MICHIGAN AVE STE 721
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7707
Mailing Address - Country:US
Mailing Address - Phone:312-343-3432
Mailing Address - Fax:
Practice Address - Street 1:9933 LAWLER AVE STE 324
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3730
Practice Address - Country:US
Practice Address - Phone:312-343-3432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1932231461OtherTYPE I NPI