Illinois State University

NPI #1770615502 in Normal, Illinois

Provider Information

NPI Number: 1770615502
Entity Type: Organization
Organization Name: Illinois State University
Primary Specialty: Psychologist - Clinical
Enumeration Date: Mar 9, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 408 FAIRCHILD HALL
Address 2: CAMPUS BOX 4625
City: Normal
State: Illinois
ZIP Code: 61790
Phone: (309) 438-5629

Authorized Official

Name: DR. BRENDA JANE HUBER, PH.D.
Title: CLINICAL PSYCHOLOGIST
Phone: (309) 438-5629

Specialties & Taxonomy Codes

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

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