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Contact Information

DR JOSEPH WALLACH PHD LLC
2530 CRAWFORD AVE
SUITE 304
EVANSTON, IL60201-4970
 Phone: 773-852-2400
 Fax: 847-869-8116
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
 

Cognitive & Behavioral

103TB0200X 62 Psychologist, Clinical
 

Health

103TH0004X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for DR JOSEPH WALLACH PHD LLC

NPI # 1336415611
LBN Legal business name DR JOSEPH WALLACH PHD LLC
Authorized official JOSEPH WALLACH - (LICENSED CLINICAL PSYCHOLOGIST)
Entity Organization
Organization subpart 1 No
Enumeration date 03/30/2012
Last updated 03/30/2012 - About 14 years ago
Identifiers
IL License # 071007942
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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