| The Prairie Clinic | |
|
1541 E Fabyan Pkwy Suite 101 Geneva IL 60134-4105 | |
| (630) 845-9644 | |
| (630) 845-9678 |
| Full Name | The Prairie Clinic |
|---|---|
| Speciality | Psychologist - Clinical Child & Adolescent |
| Location | 1541 E Fabyan Pkwy, Geneva, Illinois |
| Authorized Official Name and Position | Stacey M Wahlberg (OFFICE MANAGER) |
| Authorized Official Contact | 6308459644 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Prairie Clinic 1541 E Fabyan Pkwy Suite 101 Geneva IL 60134-4105 Ph: (630) 845-9644 | The Prairie Clinic 1541 E Fabyan Pkwy Suite 101 Geneva IL 60134-4105 Ph: (630) 845-9644 |
| NPI Number | 1184863847 |
|---|---|
| Provider Enumeration Date | 02/19/2009 |
| Last Update Date | 02/19/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184863847 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | 071006627 (Illinois) | Primary |
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