Healthcare Provider Details

I. General information

NPI: 1114180148
Provider Name (Legal Business Name): STUDIO FOR CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 N SHEFFIELD AVE STE 310
CHICAGO IL
60657-5084
US

IV. Provider business mailing address

2835 N SHEFFIELD AVE STE 310
CHICAGO IL
60657-5084
US

V. Phone/Fax

Practice location:
  • Phone: 773-281-8130
  • Fax: 773-281-7150
Mailing address:
  • Phone: 773-281-8130
  • Fax: 773-281-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-005837
License Number StateIL

VIII. Authorized Official

Name: JULIA M RAHN
Title or Position: OWNER
Credential: PH.D.
Phone: 773-281-8130