Healthcare Provider Details

I. General information

NPI: 1891602967
Provider Name (Legal Business Name): ALEJANDRA GONZALEZ LOPEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 S MICHIGAN AVE
CHICAGO IL
60605-1394
US

IV. Provider business mailing address

430 S MICHIGAN AVE
CHICAGO IL
60605-1394
US

V. Phone/Fax

Practice location:
  • Phone: 312-341-6373
  • Fax:
Mailing address:
  • Phone: 312-341-6373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071.022322
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: