Doctor Name: | SUE BAE |
NPI Number: | 1023226701 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | |
Business Practice Address: | 1754 N Washington St Suite 104a Naperville, IL - 605631334 |
Business Phone Number: | 6302450010 |
Business Fax Number: | 6302451444 |
Mailing Address: | 1754 N Washington St, Suite 104a NAPERVILLE |
State: | IL |
Postal Code: | 605631334 |
Phone Number: | 6302450010 |
Fax Number: | 6302451444 |
NPI Enumeration Date: | 05/18/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |