Moulthrop, Mark A

Moulthrop, Mark A is an sole proprietor health care provider with primary practice located at 636 Church St Suite 407, Evanston IL 60201-4508. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Neuropsychologist, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical Neuropsychologist is his primary health care specialty. Moulthrop, Mark A can be contacted via phone (847) 869-3702.

Contact Information

Primary practice address
636 Church St Suite 407 Evanston IL 60201-4508
Phone: (847) 869-3702
Fax: (847) 869-8945
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X Illinois
Behavioral Health & Social Service Providers / Clinical 103TC0700X Illinois

Profile Details

NPI number 1336294024
LBN Legal business name Moulthrop, Mark A
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 24th, 2007
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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