Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1053915223 |
---|---|
Provider Name | Lauren Hauck |
First Address | Oak Brook, IL 60523-8864 |
Second Address | Oak Brook, IL 60523-8864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2020 |
Last Update Date | 28/11/2020 |