Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | IL | |
Y | 103TC0700X | Clinical Psychologist | IL |
NPI | 1013030980 |
---|---|
Provider Name | Dr. Larry S. Wexler |
First Address | Skokie, IL 60076-2715 |
Second Address | Oak Brook, IL 60523-1320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1673382 | BLUE SHIELD (01) | IL |
R18409 | (02) | IL |