Provider Demographics
NPI:1255364253
Name:PSYCHOLOGY CONSULTANTS PC
Entity type:Organization
Organization Name:PSYCHOLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGGAU
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-745-0080
Mailing Address - Street 1:1426 FERNCROFT CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9772
Mailing Address - Country:US
Mailing Address - Phone:630-745-0080
Mailing Address - Fax:815-524-5186
Practice Address - Street 1:1426 FERNCROFT CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9772
Practice Address - Country:US
Practice Address - Phone:630-745-0080
Practice Address - Fax:815-524-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL06005952171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210626Medicare ID - Type Unspecified
ILR16980Medicare UPIN