Mundt, John Edward
Mundt, John Edward is an sole proprietor health care provider with primary practice located at 1523 William St , River Forest IL 60305-1138. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Mundt, John Edward can be contacted via phone (312) 608-0668.Contact Information
Primary practice address
1523 William St
River Forest IL 60305-1138
Phone: (312) 608-0668
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | Illinois |
Profile Details
| NPI number | 1710998596 |
|---|---|
| LBN Legal business name | Mundt, John Edward |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 10th, 2006 |
| 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710998596 | NPPES |
| Illinois | Other | 0051648579 | BLUE CROSS BLUE SHIELD |
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