Provider Demographics
NPI:1366593493
Name:LANDRE, NANCY A (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:LANDRE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 RAND RD STE 218
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2355
Mailing Address - Country:US
Mailing Address - Phone:630-546-5569
Mailing Address - Fax:
Practice Address - Street 1:960 RAND RD STE 218
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2355
Practice Address - Country:US
Practice Address - Phone:630-546-5569
Practice Address - Fax:630-470-9139
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004694103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist