| Envision Psychological Services, P.c. | |
|
1100 Cougar Trl Cary IL 60013-6057 | |
| (815) 388-9071 | |
| (847) 516-2510 |
| Full Name | Envision Psychological Services, P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 1100 Cougar Trl, Cary, Illinois |
| Authorized Official Name and Position | Susan M Stasek (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8153889071 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Envision Psychological Services, P.c. 3221 Midlane Dr Wadsworth IL 60083-9457 Ph: (815) 388-9071 | Envision Psychological Services, P.c. 1100 Cougar Trl Cary IL 60013-6057 Ph: (815) 388-9071 |
| NPI Number | 1477855328 |
|---|---|
| Provider Enumeration Date | 11/29/2010 |
| Last Update Date | 11/29/2010 |
| Medicare PECOS PAC ID | 2365621265 |
|---|---|
| Medicare Enrollment ID | O20110125000280 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477855328 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071005965 (Illinois) | Primary |
| Provider Name | Susan M Stasek |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447221528 PECOS PAC ID: 6406749332 Enrollment ID: I20040205000033 |
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