Healthcare Provider Details

I. General information

NPI: 1104218627
Provider Name (Legal Business Name): JOHN KNAPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 W BERWYN AVE STE 205
CHICAGO IL
60640-8059
US

IV. Provider business mailing address

1509 W BERWYN AVE STE 205
CHICAGO IL
60640-8059
US

V. Phone/Fax

Practice location:
  • Phone: 773-654-3322
  • Fax:
Mailing address:
  • Phone: 773-654-3322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-009037
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: