Organization
THE PRAIRIE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACEY M WAHLBERG (OFFICE MANAGER)
(630) 845-9644
Entity
Organization
Contact information
Practice address
1541 E FABYAN PKWY, SUITE 101, GENEVA, IL 60134-4105
(630) 845-9644
(630) 845-9678
Mailing address
1541 E FABYAN PKWY, SUITE 101, GENEVA, IL 60134-4105
(630) 845-9644
(630) 845-9678
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
071006627
IL
Other
Enumeration date
02/19/2009
Last updated
02/19/2009
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