14D2201857 CLIA NUMBER - ILLINOIS STATE UNIVERSITY ATHLETICS

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Laboratory Demographics

CLIA Number: 14D2201857

Facility Name: ILLINOIS STATE UNIVERSITY ATHLETICS

Facility Address:
REDBIRD ARENA RM 117
NORMAL, IL
ZIP 61790
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Facility Phone Number: 309 438-7328

Facility Type: Other - ATHLETICS

Certificate Type: Waiver

NPI Number: 1770615502

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	14D2201857
LAB Type	Other - ATHLETICS
Facility Name	ILLINOIS STATE UNIVERSITY ATHLETICS
Street	REDBIRD ARENA RM 117
City	NORMAL
State	IL
ZIP	61790
Phone	309 438-7328
CertificateType	4
CertificateEffectiveDate	11/24/2022
CertificateExpirationDate	11/23/2024
FacilityType	Waiver

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