Individual
CAROL L ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
17726 OAK PARK AVE, SUITE H, TINLEY PARK, IL 60477-3917
(708) 614-6190
(708) 614-6189
Mailing address
17726 OAK PARK AVE, SUITE H, TINLEY PARK, IL 60477-3917
(708) 614-6190
(708) 614-6189
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
034410
VALUE OPTIONS PROVIDER #
IL
01
—
1626684
BLUE CROSS PROVIDER #
IL
Enumeration date
10/02/2006
Last updated
07/08/2007
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