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Contact Information

ILLINOIS STATE UNIVERSITY
408 FAIRCHILD HALL
CAMPUS BOX 4625
NORMAL, IL61790
 Phone: 309-438-5629
 Fax: 309-438-7476
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for ILLINOIS STATE UNIVERSITY · (Female)

NPI # 1770615502
Status Active
Credentials
Entity Individual
Enumeration date 03/09/2007
Last updated 08/22/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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