Individual
MONA L ETCHISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
12255 S 80TH AVENUE, SUITE 202, PALOS HEIGHTS, IL 60463
(708) 923-7878
(708) 923-7888
Mailing address
12255 S 80TH AVENUE, SUITE 202, PALOS HEIGHTS, IL 60463
(708) 923-7878
(708) 923-7888
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0991516762
BCBS
IL
01
—
219043
MAGELLAN
IL
01
—
536182
VALUE BEHAVIORAL HEALTH
IL
01
—
7229P
CATERPILLAR
IL
Enumeration date
10/04/2006
Last updated
07/08/2007
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