Provider Demographics
NPI:1386121341
Name:PERICH, DOROTHY MARY
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MARY
Last Name:PERICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 N NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-5773
Mailing Address - Country:US
Mailing Address - Phone:847-282-0367
Mailing Address - Fax:
Practice Address - Street 1:800 E NORTHWEST HWY STE 106
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3457
Practice Address - Country:US
Practice Address - Phone:847-282-0367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional