Organization
DR JOSEPH WALLACH PHD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH WALLACH PH.D. (LICENSED CLINICAL PSYCHOLOGIST)
(773) 852-2400
Entity
Organization
Contact information
Practice address
4753 N BROADWAY ST, SUITE 608, CHICAGO, IL 60640-5266
(773) 852-2400
(847) 869-8116
Mailing address
2741 W GREENLEAF AVE, CHICAGO, IL 60645-3013
(773) 852-2400
(847) 869-8116
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
071007942
IL
103TC0700X
Clinical Psychologist
Primary
071007942
IL
103TH0004X
Health Psychologist
071007942
IL
Other
Enumeration date
04/06/2012
Last updated
04/06/2012
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