Organization
LAKESIDE PSYCHOLOGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JULIE WIEGEL PSYD (PRESIDENT)
(847) 594-2880
Entity
Organization
Contact information
Practice address
1110 W LAKE COOK RD, SUITE 150, BUFFALO GROVE, IL 60089-1944
(847) 594-2880
Mailing address
1110 W LAKE COOK RD, SUITE 150, BUFFALO GROVE, IL 60089-1944
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
071007686
IL
Other
Enumeration date
03/03/2010
Last updated
03/03/2010
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