Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071002314 | IL |
Y | 103TC0700X | Clinical Psychologist | 071002314 | IL |
NPI | 1003886938 |
---|---|
Provider Name | Dr. Dale Susan Gody |
First Address | Wilmette, IL 60091-2963 |
Second Address | Wilmette, IL 60091-2963 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 08/07/2007 |