Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | IL |
NPI | 1093839987 |
---|---|
Provider Name | Dr. Chinni Chilamkurti |
First Address | Grayslake, IL 60030-7817 |
Second Address | Grayslake, IL 60030-7817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2007 |
Last Update Date | 08/07/2007 |