Provider Demographics
NPI:1104923408
Name:DRUMMOND, MARC (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:DRUMMOND
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 FLINTLOCK CT
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8770
Mailing Address - Country:US
Mailing Address - Phone:630-301-0658
Mailing Address - Fax:
Practice Address - Street 1:1700 N FARNSWORTH AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-1523
Practice Address - Country:US
Practice Address - Phone:630-851-6100
Practice Address - Fax:630-851-6154
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003279101YP2500X
IL071008271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional