| Chicagoland Neuropsychology Llc | |
|
101 N Marion St Ste 313 Oak Park IL 60301-1167 | |
| (773) 931-3439 | |
| Not Available |
| Full Name | Chicagoland Neuropsychology Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 101 N Marion St, Oak Park, Illinois |
| Authorized Official Name and Position | Colin Brietzke (OWNER) |
| Authorized Official Contact | 7739313439 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chicagoland Neuropsychology Llc 101 N Marion St Ste. 313 Oak Park IL 60301-1167 Ph: (773) 931-3439 | Chicagoland Neuropsychology Llc 101 N Marion St Ste 313 Oak Park IL 60301-1167 Ph: (773) 931-3439 |
| NPI Number | 1275946048 |
|---|---|
| Provider Enumeration Date | 06/09/2014 |
| Last Update Date | 06/09/2014 |
| Medicare PECOS PAC ID | 6901343334 |
|---|---|
| Medicare Enrollment ID | O20240802003702 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275946048 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 071.008376 (Illinois) | Primary |
| Provider Name | Colin A Brietzke |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558626267 PECOS PAC ID: 0749586428 Enrollment ID: I20160307000512 |
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