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Individual
DR. W DOUGLAS VASELAKOS
Active
Individual
DR. W DOUGLAS VASELAKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
Primary
071006093
IL
103TC0700X
Clinical Psychologist
071006093
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001622805
BLUECROSS PROVIDER NUMBER
IL
01
—
364250769
TAX IDENTIFICATION NUMBER
IL
Enumeration date
10/25/2006
Last updated
04/03/2024
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