Organization
CLINICAL ASSIST, LTD.
Active
Other names
Black Bear Academy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORI G TALL PSYD (EXECUTIVE DIRECTOR)
(312) 285-2323
Entity
Organization
Contact information
Practice address
1801 W BYRON ST, CHICAGO, IL 60613-2729
(773) 244-0700
(773) 244-0200
Mailing address
1801 W BYRON ST, CHICAGO, IL 60613-2729
(773) 244-0700
(773) 244-0200
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
252Y00000X
Early Intervention Provider Agency
060006146
IL
Other
Enumeration date
08/11/2011
Last updated
01/11/2021
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