| Great Lakes Neuropsychology & Counseling Llc | |
|
5758 Elaine Dr Rockford IL 61108-3102 | |
| (815) 231-1280 | |
| (815) 231-1282 |
| Full Name | Great Lakes Neuropsychology & Counseling Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 5758 Elaine Dr, Rockford, Illinois |
| Authorized Official Name and Position | Shaun A Bong (LICENSED CLINICAL PSYCHOLOGIST/MEMB) |
| Authorized Official Contact | 8152311280 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Neuropsychology & Counseling Llc 5758 Elaine Dr Rockford IL 61108-3102 Ph: (815) 231-1280 | Great Lakes Neuropsychology & Counseling Llc 5758 Elaine Dr Rockford IL 61108-3102 Ph: (815) 231-1280 |
| NPI Number | 1013030725 |
|---|---|
| Provider Enumeration Date | 04/09/2007 |
| Last Update Date | 02/05/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013030725 | NPI | - | NPPES |
| 215368 | Other | IL | MEDICARE PTAN |
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