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Organization
UNIVERSITY OF ILLINOIS
Active
Organization
UNIVERSITY OF ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISELA HUERTA PH.D. (VISITING STAFF PSYCHOLOGIST)
(312) 413-1741
Entity
Organization
Contact information
Practice address
1747 W ROOSEVELT RD, CHICAGO, IL 60608-1264
(312) 413-1741
Mailing address
1747 W ROOSEVELT RD, CHICAGO, IL 60608-1264
(312) 413-1741
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071007706
IL
Other
Enumeration date
07/10/2009
Last updated
07/10/2009
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