Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | IL | |
Y | 103TC0700X | Clinical Psychologist | IL |
NPI | 1013046481 |
---|---|
Provider Name | Diane Selinger |
First Address | Skokie, IL 60077-4405 |
Second Address | Glenview, IL 60025-2370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2007 |
Last Update Date | 08/07/2007 |