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Individual

DR. SANDRA ELLEN JOHNSON CLAVELLI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PSY.D.

Contact information

Practice address
420 W. GRAND AVE, LAKE VILLA, IL 60046
(847) 245-6469
Mailing address
2699 HOBSON RD APT 6, WOODRIDGE, IL 60517-1550
(847) 636-7637

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
71007250
IL

Other

Enumeration date
05/16/2007
Last updated
07/08/2007
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