Organization
DENNIS J NISWONGER, PSY.D, S.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS J NISWONGER PSY.D (OWNER)
(708) 364-3232
Entity
Organization
Contact information
Practice address
15040 S RAVINIA AVE, SUITE 49, ORLAND PARK, IL 60462-3194
(708) 364-3232
(708) 364-3233
Mailing address
15040 S RAVINIA AVE, SUITE 49, ORLAND PARK, IL 60462-3194
(708) 364-3232
(708) 364-3233
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-007045
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639275
BLUECROSS/BLUESHIELD
IL
Enumeration date
04/14/2008
Last updated
02/18/2010
Update your record
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