Healthcare Provider Details

I. General information

NPI: 1225381809
Provider Name (Legal Business Name): JESSICA RANSOM PSY.D. MSCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 N RAVENSWOOD AVE UNIT 320
CHICAGO IL
60640-4417
US

IV. Provider business mailing address

4809 N RAVENSWOOD AVE UNIT 320
CHICAGO IL
60640-4417
US

V. Phone/Fax

Practice location:
  • Phone: 773-800-1510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007126
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number074000004
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: