MEDICARE: DR. ALEXIS WESTBROOK

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	103T00000X	Psychologist
2	103TC0700X	Clinical Psychologist	071.010520	IL

General Provider Information

NPI Number	:	1467036301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS WESTBROOK

Provider Business Mailing Address
First Line	:	9923 RIDGELAND AVE UNIT 96
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-1262
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 S BLUE ISLAND AVE STE 497
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2133
Country	:	US
Telephone Number	:	708-966-7506
Fax Number	:

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

Provider Enumeration Date	:	05/06/2021
Last Update Date	:	08/23/2023

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Directions to “ DR. ALEXIS WESTBROOK ” Practice Location

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