Most Relevant Information
Provider Data
| NPI Number: | 1003023714 |
| Provider Name: | SANDRA ELLEN JOHNSON CLAVELLI PSY.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 103TC0700X |
| Specialty: | Psychologist |
| License Number: | 71007250 |
Most Important Dates
| Enumeration Date: | 05/16/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
420 W. GRAND AVE
LAKE VILLA
IL
60046
Practice Location Phone/Fax
| Phone: | 8472456469 |
| Fax: |
Provider Mailing Location
2699 HOBSON RD APT 6
WOODRIDGE
IL
605171550
Provider Mailing Phone/Fax
| Phone: | 8476367637 |
| Fax: |