Provider Demographics
NPI:1528325438
Name:DEIDRE ALEXANDER PSYD SC
Entity type:Organization
Organization Name:DEIDRE ALEXANDER PSYD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DC
Authorized Official - Middle Name:
Authorized Official - Last Name:MCAULIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-712-6183
Mailing Address - Street 1:1000 JORIE BLVD STE 119
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-4463
Mailing Address - Country:US
Mailing Address - Phone:630-309-2989
Mailing Address - Fax:630-790-3804
Practice Address - Street 1:1000 JORIE BLVD STE 119
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4463
Practice Address - Country:US
Practice Address - Phone:630-309-2989
Practice Address - Fax:630-790-3804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEIDRE ALEXANDER PSYD SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-16
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL017.008341103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty