| Organization Name: | ILLINOIS GERIATRIC PSYCHOLOGICAL SERVICES P.C. |
| NPI Number: | 1184999310 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PETER M KOEHN (PRESIDENT) |
| Mailing Address: | 503 4th St Harvard |
| State: | IL US |
| Postal Code: | 600332311 |
| Phone Number: | 8152123209 |
| Fax Number: | |
| NPI Enumeration Date: | 03/21/2012 |
| NPI Last Update Date: | 03/21/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 071007428 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |