Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071008426 | IL |
Y | 103TC0700X | Clinical Psychologist | 071008426 | IL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 071008426 | IL |
N | 103TF0000X | Family Psychologist | 071008426 | IL |
NPI | 1093067589 |
---|---|
Provider Name | Dr. Jenna Mary Felczak-Berberich |
First Address | Oak Lawn, IL 60453-2533 |
Second Address | Oak Lawn, IL 60453-2533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2012 |
Last Update Date | 16/01/2013 |