Provider Demographics
NPI:1932336880
Name:NORTH SUBURBAN PSYCHOLOGICAL ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:NORTH SUBURBAN PSYCHOLOGICAL ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUNTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-835-1770
Mailing Address - Street 1:630 VERNON
Mailing Address - Street 2:SUITE G
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022
Mailing Address - Country:US
Mailing Address - Phone:847-835-1770
Mailing Address - Fax:847-835-5358
Practice Address - Street 1:630 VERNON AVE
Practice Address - Street 2:SUITE G
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1681
Practice Address - Country:US
Practice Address - Phone:847-835-1770
Practice Address - Fax:847-835-5358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty