Organization
LINCOLN PARK PSYCHOLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHRYN JESSIE WAX PSY.D. (CLINICAL PSYCHOLOGIST/PRESIDENT)
(773) 991-3016
Entity
Organization
Contact information
Practice address
644 W WEBSTER AVE # B, CHICAGO, IL 60614-3710
(773) 991-3016
Mailing address
644 W WEBSTER AVE # B, CHICAGO, IL 60614-3710
(773) 991-3016
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497137046
—
IL
Enumeration date
09/25/2020
Last updated
10/23/2020
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