Provider Demographics
NPI:1720484660
Name:LIN, DIANE LAI SHEONG (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LAI SHEONG
Last Name:LIN
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 1:879 N HAMILTON CT
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-3483
Mailing Address - Country:US
Mailing Address - Phone:847-772-3546
Mailing Address - Fax:
Practice Address - Street 1:610 W ROOSEVELT RD
Practice Address - Street 2:SUITE B-1
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5087
Practice Address - Country:US
Practice Address - Phone:630-462-3999
Practice Address - Fax:630-462-0911
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.005050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical