MADELINE POLONIA LONG Clinical Psychologist License verification

Business Entity

NOT RENEWED

License Type

Clinical Psychologist

Description

CLINICAL PSYCHOLOGIST

License Number

071006212

License Status

NOT RENEWED

Business

First Name

MADELINE

Middle

POLONIA

Last Name

LONG

Business Name

MADELINE POLONIA LONG

Original Issue Date

01/29/2001

Effective Date

10/15/2002

Expiration Date

09/30/2002

City

CHICAGO

State

Zip

60618

County

COOK

Ever Disciplined

LastModifiedDate

09/11/2005