Provider Demographics
NPI:1184707549
Name:NISONOFF, LINDA A (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:A
Last Name:NISONOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 KALAMAZOO DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6327
Mailing Address - Country:US
Mailing Address - Phone:630-983-7047
Mailing Address - Fax:630-717-1165
Practice Address - Street 1:445 W JACKSON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5256
Practice Address - Country:US
Practice Address - Phone:630-355-5514
Practice Address - Fax:630-717-1165
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical