Provider Demographics
NPI:1720425044
Name:CLATCH, MICHAEL JOHN (PSY D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:CLATCH
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 RAVINE WAY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7652
Mailing Address - Country:US
Mailing Address - Phone:847-730-3042
Mailing Address - Fax:847-730-3382
Practice Address - Street 1:2400 RAVINE WAY
Practice Address - Street 2:SUITE 600
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7652
Practice Address - Country:US
Practice Address - Phone:847-730-3042
Practice Address - Fax:847-730-3382
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008602103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical