Provider Demographics
NPI:1730525148
Name:WELLINGTON PSYCHOLOGICAL SERVICES, PC
Entity type:Organization
Organization Name:WELLINGTON PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:G
Authorized Official - Last Name:PALACIO
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:312-402-0550
Mailing Address - Street 1:3000 N SHERIDAN RD APT 15D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5581
Mailing Address - Country:US
Mailing Address - Phone:312-402-0550
Mailing Address - Fax:
Practice Address - Street 1:3000 N SHERIDAN RD APT 15D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5581
Practice Address - Country:US
Practice Address - Phone:312-402-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty