Individual
MRS. PAULA RUTH CORMALLETH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY D
Contact information
Practice address
75 E WACKER DRIVE, SUITE 600, CHICAGO, IL 60601
(312) 553-9010
Mailing address
75 E WACKER DRIVE, SUITE 600, CHICAGO, IL 60601
(312) 553-9010
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001673076
BLUE CROSS BLUE SHIELD
—
Enumeration date
01/25/2007
Last updated
07/08/2007
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