Healthcare Provider Details

I. General information

NPI: 1801300439
Provider Name (Legal Business Name): RACHEL ELIZABETH SMITH PSYD, MA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 W CHICAGO AVE STE 202
CHICAGO IL
60622-4377
US

IV. Provider business mailing address

2950 W CHICAGO AVE STE 202
CHICAGO IL
60622-4377
US

V. Phone/Fax

Practice location:
  • Phone: 773-627-2112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.009661
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: