Healthcare Provider Details

I. General information

NPI: 1780167411
Provider Name (Legal Business Name): JENNIFER DIAMOND PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 W NORTH AVE STE 750
CHICAGO IL
60642-7142
US

IV. Provider business mailing address

910 W ARMITAGE AVE
CHICAGO IL
60614-4204
US

V. Phone/Fax

Practice location:
  • Phone: 262-885-1977
  • Fax:
Mailing address:
  • Phone: 312-802-9876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number171010185
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: