Provider Demographics
NPI:1932364353
Name:LINDA D. SMALL, PH.D AND ASSOCIATES
Entity Type:Organization
Organization Name:LINDA D. SMALL, PH.D AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-968-4300
Mailing Address - Street 1:6800 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 14
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3495
Mailing Address - Country:US
Mailing Address - Phone:630-968-4300
Mailing Address - Fax:630-968-4385
Practice Address - Street 1:6800 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 14
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3495
Practice Address - Country:US
Practice Address - Phone:630-968-4300
Practice Address - Fax:630-968-4385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0970472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071-004196Medicaid
IL071-004196Medicaid