MEDICARE: DR. TONY A FLETCHER PSY.D.

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
1	103TC0700X	Clinical Psychologist	071-005279	IL
2	103G00000X	Clinical Neuropsychologist	071-005279	IL

General Provider Information

NPI Number	:	1104854892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONY A FLETCHER PSY.D.

Provider Business Mailing Address
First Line	:	1205 LINDEN AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1244
Country	:	US
Telephone Number	:	312-961-9974
Fax Number	:	312-285-2151

Provider Business Practice Location Address
First Line	:	53 W JACKSON BLVD STE 1522
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-3761
Country	:	US
Telephone Number	:	312-961-9974
Fax Number	:	312-285-2151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	01/09/2026

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