| Board Of Trustees Of The University Of Illinois | |
|
301 N Neil St Ste 210 Champaign IL 61820-3166 | |
| (217) 244-4597 | |
| Not Available |
| Full Name | Board Of Trustees Of The University Of Illinois |
|---|---|
| Speciality | Psychologist |
| Location | 301 N Neil St Ste 210, Champaign, Illinois |
| Authorized Official Name and Position | Avijit Ghosh (COMPTROLLER) |
| Authorized Official Contact | 2173331202 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Board Of Trustees Of The University Of Illinois 603 East Daniel Street Room 327, Brenda Reinhold Champaign IL 61820 Ph: (217) 244-4613 | Board Of Trustees Of The University Of Illinois 301 N Neil St Ste 210 Champaign IL 61820-3166 Ph: (217) 244-4597 |
| NPI Number | 1104401454 |
|---|---|
| Provider Enumeration Date | 03/17/2021 |
| Last Update Date | 03/17/2021 |
| Certification Date | 03/17/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104401454 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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