Individual
DR. IVAN A. WOLFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
149 OAK KNOLL TER, HIGHLAND PARK, IL 60035-5320
(847) 433-4450
(847) 433-5464
Mailing address
149 OAK KNOLL TER, HIGHLAND PARK, IL 60035-5320
(847) 433-4450
(847) 433-5464
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-005558
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5988-151-5
INCORPORATION FILENUMBER
IL
Enumeration date
01/07/2006
Last updated
05/14/2014
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