Individual
DR. NICOLE A TEFERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
16624 LUELLA AVE, SOUTH HOLLAND, IL 60473-2617
(708) 466-5247
Mailing address
16624 LUELLA AVE, SOUTH HOLLAND, IL 60473-2617
(708) 466-5247
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
071007772
IL
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
071007772
IL
Other
Enumeration date
03/05/2010
Last updated
03/05/2010
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