MEDICARE: JOSEPH CHEN PH.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	071007676	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	071-007676	OTHER	IL	071007676

General Provider Information

NPI Number	:	1114152816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH CHEN PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 2193
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60065-2193
Country	:	US
Telephone Number	:	312-835-7988
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 W JACKSON BLVD STE 824
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-3487
Country	:	US
Telephone Number	:	312-835-7988
Fax Number	:

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

Provider Enumeration Date	:	05/25/2009
Last Update Date	:	02/17/2020

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