Healthcare Provider Details

I. General information

NPI: 1255056552
Provider Name (Legal Business Name): ALIZA JAFFE SASS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N HALSTED ST STE 402
CHICAGO IL
60642-2607
US

IV. Provider business mailing address

626 W BUCKINGHAM PL APT 1E
CHICAGO IL
60657-6543
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-2800
  • Fax:
Mailing address:
  • Phone: 847-650-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: