Healthcare Provider Details

I. General information

NPI: 1427797471
Provider Name (Legal Business Name): ROSS MONDSCHAIN MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2022
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 W NORTH AVE
CHICAGO IL
60642-7138
US

IV. Provider business mailing address

3660 N LAKE SHORE DR APT 4608
CHICAGO IL
60613-5320
US

V. Phone/Fax

Practice location:
  • Phone: 312-779-6131
  • Fax:
Mailing address:
  • Phone: 312-451-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.016715
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: