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14D1017109 CLIA NUMBER - ILLINOIS DERMATOLOGY INSTITUTE

Laboratory Demographics

CLIA Number: 14D1017109

Facility Name: ILLINOIS DERMATOLOGY INSTITUTE

Facility Address:
3000 N HALSTED STE 409
CHICAGO, IL
ZIP 60657
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Facility Phone Number: 773 281-9200

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1134641103

Taxonomy: 103TC0700X - Psychologist
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

CLIA Record

Field Name Field Value
CLIA Number 14D1017109
LAB Type Physician Office
Facility Name ILLINOIS DERMATOLOGY INSTITUTE
Street 3000 N HALSTED STE 409
City CHICAGO
State IL
ZIP 60657
Phone 773 281-9200
CertificateType 4
CertificateEffectiveDate 2/14/2024
CertificateExpirationDate 2/13/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024