Provider Demographics
NPI:1902138803
Name:NAPERVILLE PEDIATRIC PSYCHOLOGY & DEVELOPMENT
Entity Type:Organization
Organization Name:NAPERVILLE PEDIATRIC PSYCHOLOGY & DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MANFRE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-548-9237
Mailing Address - Street 1:1220 HOBSON ROAD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540
Mailing Address - Country:US
Mailing Address - Phone:630-548-9237
Mailing Address - Fax:630-548-9366
Practice Address - Street 1:1220 HOBSON RD
Practice Address - Street 2:SUITE 112
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8139
Practice Address - Country:US
Practice Address - Phone:630-548-9237
Practice Address - Fax:630-548-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71.007476103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty