Organization
PRAIRIE PSYCHOTHERAPY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY H. MACDONALD PSY.D. (OWNER)
(630) 879-8164
Entity
Organization
Contact information
Practice address
335 N RIVER ST, SUITE 210, BATAVIA, IL 60510-2386
(630) 879-8164
Mailing address
335 N RIVER ST #210, BATAVIA, IL 60510
(630) 879-8164
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071005595
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4523298
BLUE CROSS BLUE SHIELD OF ILLINOIS
IL
Enumeration date
07/08/2010
Last updated
11/30/2023
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