Provider Demographics
NPI:1427709393
Name:WAHLBERG PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:WAHLBERG PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-776-1181
Mailing Address - Street 1:2320 DEAN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1068
Mailing Address - Country:US
Mailing Address - Phone:630-776-1181
Mailing Address - Fax:
Practice Address - Street 1:2320 DEAN ST STE 201
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1068
Practice Address - Country:US
Practice Address - Phone:630-776-1181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty