Organization
THAMANI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN WILDT (EXECUTIVE ASSISTANT)
(217) 370-7540
Entity
Organization
Contact information
Practice address
3036 W IRVING PARK RD, CHICAGO, IL 60618-3539
(773) 270-2150
Mailing address
2020 N CALIFORNIA AVE STE 7, BOX 220, CHICAGO, IL 60647-6320
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071009493
IL
Other
Enumeration date
08/20/2018
Last updated
08/20/2018
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