Provider Demographics
NPI:1427501469
Name:CHICAGO NEURODEVELOPMENTAL CENTER
Entity type:Organization
Organization Name:CHICAGO NEURODEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-272-2484
Mailing Address - Street 1:601 SKOKIE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2851
Mailing Address - Country:US
Mailing Address - Phone:847-272-2484
Mailing Address - Fax:
Practice Address - Street 1:601 SKOKIE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2851
Practice Address - Country:US
Practice Address - Phone:847-272-2484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008032103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty