| Doctor Name: | DR. DALE SUSAN GODY |
| NPI Number: | 1003886938 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 071002314 |
| Business Practice Address: | 3330 Old Glenview Rd Suite 16 Wilmette, IL - 600912963 |
| Business Phone Number: | 8472517774 |
| Business Fax Number: | 8472519897 |
| Mailing Address: | 3330 Old Glenview Rd, Suite 16 WILMETTE |
| State: | IL |
| Postal Code: | 600912963 |
| Phone Number: | 8472517774 |
| Fax Number: | 8472519897 |
| NPI Enumeration Date: | 01/24/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 071002314 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |