MINDY ERIN FORMAN Clinical Psychologist License verification

Business Entity

ACTIVE

License Type

Clinical Psychologist

Description

CLINICAL PSYCHOLOGIST

License Number

071009917

License Status

ACTIVE

Business

First Name

MINDY

Middle

ERIN

Last Name

FORMAN

Business Name

MINDY ERIN FORMAN

Original Issue Date

12/03/2018

Effective Date

08/26/2024

Expiration Date

09/30/2026

City

DEERFIELD

State

Zip

60015

County

LAKE

Ever Disciplined

LastModifiedDate

08/26/2024