Organization
ANDERSONVILLE PSYCHOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN SMITH PSYD (PRESIDENT)
(773) 985-8746
Entity
Organization
Contact information
Practice address
5412 N CLARK ST STE 220, CHICAGO, IL 60640-1272
(773) 985-8746
Mailing address
1641 W FARWELL AVE APT NB, CHICAGO, IL 60626-6064
(773) 985-8746
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.009490
IL
Other
Enumeration date
07/12/2017
Last updated
07/12/2017
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