Provider Demographics
NPI:1649493586
Name:DEBOER, MARILYN M (PHD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:M
Last Name:DEBOER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:829 RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2429
Mailing Address - Country:US
Mailing Address - Phone:847-869-4270
Mailing Address - Fax:
Practice Address - Street 1:1306 WAUKEGAN RD
Practice Address - Street 2:#201
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3072
Practice Address - Country:US
Practice Address - Phone:847-901-0909
Practice Address - Fax:847-901-0910
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.004805103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL458586OtherNEUROFEEDBACK