Healthcare Provider Details

I. General information

NPI: 1265919039
Provider Name (Legal Business Name): BRIDGEPOINT PSYCHOLOGY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5547 N RAVENSWOOD AVE STE 201
CHICAGO IL
60640-1125
US

IV. Provider business mailing address

5547 N RAVENSWOOD AVE STE 201
CHICAGO IL
60640-1125
US

V. Phone/Fax

Practice location:
  • Phone: 773-634-8112
  • Fax:
Mailing address:
  • Phone: 773-634-8112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. RACHAEL LARAY CALTON
Title or Position: DIRECTOR OF OPERATIONS & INSURANCE
Credential:
Phone: 847-502-7277