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61 S Old Rand Rd Lake Zurich IL 60047-3127 | |
| (815) 578-4222 | |
| (847) 438-0844 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 61 S Old Rand Rd, Lake Zurich, Illinois |
| Authorized Official Name and Position | Keith V Bjorge (PRESIDENT/PSYCHOLOGIST) |
| Authorized Official Contact | 8155784222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
61 S Old Rand Rd Lake Zurich IL 60047-3127 Ph: (815) 578-4222 | 61 S Old Rand Rd Lake Zurich IL 60047-3127 Ph: (815) 578-4222 |
| NPI Number | 1790854636 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 11/10/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790854636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 2091057 (Wisconsin) | Secondary |
| 103TC0700X | Psychologist - Clinical | 071005483 (Illinois) | Primary |
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