Healthcare Provider Details

I. General information

NPI: 1902299159
Provider Name (Legal Business Name): DANIELLE SIMMONS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 W JACKSON BLVD
CHICAGO IL
60607-2914
US

IV. Provider business mailing address

1016 W JACKSON BLVD
CHICAGO IL
60607-2914
US

V. Phone/Fax

Practice location:
  • Phone: 872-216-3241
  • Fax:
Mailing address:
  • Phone: 872-216-3241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071008235
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: