Individual
PATRICIA DIANE DORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1030 N STATE ST, 45E, CHICAGO, IL 60610
(312) 943-8321
Mailing address
1030 N STATE ST, 45E, CHICAGO, IL 60610
(312) 943-8321
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
71001210
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001672818
BCBS ILLINOIS
IL
Enumeration date
05/09/2007
Last updated
07/08/2007
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