Organization
ISAAC RAY CENTER AT CERMAK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY LYNN KUSHNEREIT PSYD (PSYCHOLOGIST)
(248) 765-7127
Entity
Organization
Contact information
Practice address
3159 N SEMINARY #301, CHICAGO, IL 60657
(248) 765-7127
Mailing address
3159 N SEMINARY AVE APT 301, CHICAGO, IL 60657-3357
(248) 765-7127
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
071.007792
IL
Other
Enumeration date
02/05/2010
Last updated
02/05/2010
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