Healthcare Provider Details

I. General information

NPI: 1063878833
Provider Name (Legal Business Name): DR. JESSICA RANSOM AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4043 N RAVENSWOOD AVE 227
CHICAGO IL
60613-1155
US

IV. Provider business mailing address

4043 N RAVENSWOOD AVE 227
CHICAGO IL
60613-1155
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 Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007126
License Number StateIL

VIII. Authorized Official

Name: DR. JESSICA RANSOM
Title or Position: CLINICAL PSYCHOLOGIST/OWNER
Credential:
Phone: 773-800-1510