Individual
DR. THERESA C RISOLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
7055 VETERANS BLVD STE C, BURR RIDGE, IL 60527-5641
(708) 246-2637
Mailing address
4 SUMMIT AVE, ROCKPORT, MA 01966-1411
(708) 955-2806
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-003688
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL 071-003688
LICENSE
IL
Enumeration date
08/10/2006
Last updated
10/24/2023
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