Provider Demographics
NPI:1780701359
Name:LIND, JEROLD O'NEIL (PHD)
Entity type:Individual
Prefix:DR
First Name:JEROLD
Middle Name:O'NEIL
Last Name:LIND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:708 CHURCH ST
Mailing Address - Street 2:STE. 258
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3875
Mailing Address - Country:US
Mailing Address - Phone:847-619-1348
Mailing Address - Fax:947-475-0356
Practice Address - Street 1:708 CHURCH ST
Practice Address - Street 2:STE. 258
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3875
Practice Address - Country:US
Practice Address - Phone:847-619-1348
Practice Address - Fax:947-475-0356
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
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