Healthcare Provider Details

I. General information

NPI: 1578941530
Provider Name (Legal Business Name): REEMA OBAID ROSS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MERCHANDISE MART PLZ 4TH FLOOR- #4121
CHICAGO IL
60654-1103
US

IV. Provider business mailing address

505 N LAKE SHORE DR UNIT 3903
CHICAGO IL
60611-3427
US

V. Phone/Fax

Practice location:
  • Phone: 219-771-0625
  • Fax:
Mailing address:
  • Phone: 219-771-0625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008537
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: