Psychological Associates Professionals Llc | |
5409 N Knoxville Ave Peoria IL 61614 | |
(309) 691-0420 | |
(309) 691-0520 |
Full Name | Psychological Associates Professionals Llc |
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Speciality | Psychologist |
Location | 5409 N Knoxville Ave, Peoria, Illinois |
Authorized Official Name and Position | Donald R Legan (CLINICAL PSYCHOLOGIST) |
Authorized Official Contact | 3096910420 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Psychological Associates Professionals Llc 5409 N Knoxville Ave Peoria IL 61614 Ph: (309) 691-0420 | Psychological Associates Professionals Llc 5409 N Knoxville Ave Peoria IL 61614 Ph: (309) 691-0420 |
NPI Number | 1952378192 |
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Provider Enumeration Date | 03/07/2006 |
Last Update Date | 08/17/2017 |
Medicare PECOS PAC ID | 5193795557 |
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Medicare Enrollment ID | O20040731000085 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952378192 | NPI | - | NPPES |
07220997 | Other | BCBS | |
L015956 | Other | CHAMPUS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | 71002085 (Illinois) | Primary |
Provider Name | Leone C Legan |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1710954953 PECOS PAC ID: 3870564008 Enrollment ID: I20040803000234 |
Provider Name | Donald R Legan |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1467429605 PECOS PAC ID: 9739159195 Enrollment ID: I20100113000483 |
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