Department of Veterans Affairs

NPI #1528380706 in Marion, Illinois

Provider Information

NPI Number: 1528380706
Entity Type: Organization
Organization Name: Department of Veterans Affairs
Primary Specialty: Psychologist - Clinical
Enumeration Date: Feb 16, 2010
Last Updated: Feb 16, 2010

Practice Location

Address: 2401 W MAIN ST
City: Marion
State: Illinois
ZIP Code: 62959-1188
Phone: (618) 997-5311

Authorized Official

Name: MR. JAMES W. ROSEBOROUGH
Title: MEDICAL CENTER DIRECTOR
Phone: (618) 997-5311

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X	Primary

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