Individual
MR. PERSELL JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11337 S WALLACE ST, CHICAGO, IL 60628-4729
(773) 698-3088
Mailing address
11337 S WALLACE ST, CHICAGO, IL 60628-4729
(773) 698-3088
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1110-1110
IL
Other
Enumeration date
08/30/2023
Last updated
08/30/2023
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