Individual
GRETCHEN A BOULES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
33 S GARFIELD AVE, HINSDALE, IL 60521
(630) 321-9809
Mailing address
200 S FRONTAGE RD STE 324, BURR RIDGE, IL 60527-6953
(630) 321-9809
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
071005051
IL
103TP0016X
Prescribing (Medical) Psychologist
Primary
074.000005
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001621856
BC BS OF IL
IL
Enumeration date
09/14/2006
Last updated
02/24/2022
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