Provider Demographics
NPI:1962927624
Name:FREE BIRD PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:FREE BIRD PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOLK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-410-2029
Mailing Address - Street 1:8170 MCCORMICK BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2914
Mailing Address - Country:US
Mailing Address - Phone:847-410-2029
Mailing Address - Fax:847-410-2041
Practice Address - Street 1:8170 MCCORMICK BLVD STE 204
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2914
Practice Address - Country:US
Practice Address - Phone:847-410-2029
Practice Address - Fax:847-410-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009469103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty