Organization
ASSOCIATES FOR INNOVATIVE CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHRYN R JUZWIN PSYD (CLINICAL PSYCHOLOGIST)
(224) 678-9033
Entity
Organization
Contact information
Practice address
210 S 5TH ST STE 103, ST CHARLES, IL 60174-2700
(224) 678-9033
Mailing address
210 S 5TH ST STE 103, ST CHARLES, IL 60174-2700
(224) 678-9033
(224) 678-9493
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518158948
CLINICAL PSYCHOLOGIST
IL
Enumeration date
07/08/2017
Last updated
06/16/2018
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