Provider Demographics
NPI:1154063238
Name:NATALIE JO PETROVICH, PLLC
Entity type:Organization
Organization Name:NATALIE JO PETROVICH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:PETROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-364-8306
Mailing Address - Street 1:939 W WASHINGTON BLVD APT 513
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2263
Mailing Address - Country:US
Mailing Address - Phone:630-364-8306
Mailing Address - Fax:
Practice Address - Street 1:939 W WASHINGTON BLVD APT 513
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2263
Practice Address - Country:US
Practice Address - Phone:630-364-8306
Practice Address - Fax:844-990-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-10
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1649764010OtherPSYCHOLOGIST