Individual
DR. EDWARD SPENCER LANDRETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
4709 GOLF ROAD, SUITE 1150, SKOKIE, IL 60076-1252
(773) 213-1232
Mailing address
4709 GOLF ROAD, SUITE 1150, SKOKIE, IL 60076-1252
(773) 213-1232
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071006758
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001635205
BCBS IL
IL
Enumeration date
06/08/2006
Last updated
04/06/2016
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