Organization
SOUTHERN ILLINOIS UNIVERSITY CARBONDALE CLINICAL CENTER
Active
Parent organization
SOUTHERN ILLINOIS UNIVERSITY CARBONDALE
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHERN ILLINOIS UNIVERSITY CARBONDALE
Authorized official
HOLLY CORMIER PHD (DIRECTOR)
(618) 453-2361
Entity
Organization
Contact information
Practice address
625 WHAM DRIVE ROOM 141, CARBONDALE, IL 62901
(618) 453-2361
(618) 453-6130
Mailing address
625 WHAM DRIVE ROOM 141, CARBONDALE, IL 62901
(618) 453-2361
(618) 453-6130
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TC1900X
Counseling Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
04/14/2015
Last updated
04/14/2015
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