Individual
DR. MARYLOU NALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD.
Contact information
Practice address
708 FLORSHEIM DR, SUITE 13, LIBERTYVILLE, IL 60048-5001
(847) 561-2397
Mailing address
708 FLORSHEIM DR, #13, LIBERTYVILLE, IL 60048-5001
(847) 561-2397
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071007149
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4932686
BCBS
IL
Enumeration date
09/23/2006
Last updated
08/25/2015
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