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NPI Code Detail

MEDICARE: ABIGAIL HERROLD

MEDICARE: ABIGAIL HERROLD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist071.022435IL

General Provider Information

NPI Number : 1083265524
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL HERROLD
Provider Business Mailing Address
First Line : 2732 N CLARK ST STE 300
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1553
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2732 N CLARK ST STE 300
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1553
Country : US
Telephone Number : 773-250-1769
Fax Number : 773-250-1769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2019
Last Update Date : 03/24/2026

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