Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 071.008667 | IL |
NPI | 1093143604 |
---|---|
Provider Name | Dr. Diane Chen |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60614-1881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2013 |
Last Update Date | 16/10/2013 |