Individual
DR. W DOUGLAS VASELAKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
700 RAVINIA PL, ORLAND PARK, IL 60462-3700
(708) 226-0010
(708) 226-0040
Mailing address
700 RAVINIA PL, ORLAND PARK, IL 60462-3700
(708) 226-0010
(708) 226-0040
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
Primary
071006093
IL
103TC0700X
Clinical Psychologist
071006093
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001622805
BLUECROSS PROVIDER NUMBER
IL
01
—
364250769
TAX IDENTIFICATION NUMBER
IL
Enumeration date
10/25/2006
Last updated
04/03/2024
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