Healthcare Provider Details

I. General information

NPI: 1942167648
Provider Name (Legal Business Name): PAIGE FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4621 N RAVENSWOOD AVE
CHICAGO IL
60640-4509
US

IV. Provider business mailing address

700 W BITTERSWEET PL APT 309
CHICAGO IL
60613-2355
US

V. Phone/Fax

Practice location:
  • Phone: 773-413-9523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.021441
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: