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Individual

THANE DYKSTRA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
18100 W OAK AVE, LOCKPORT, IL 60441-6125
(815) 723-4894
Mailing address
2458 ERSKINE RD, JOLIET, IL 60433-1612

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
71005980
IL

Other

Enumeration date
06/29/2007
Last updated
07/08/2007
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