Healthcare Provider Details

I. General information

NPI: 1912790452
Provider Name (Legal Business Name): PRIYANKA RAO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 N SHERIDAN RD SUITE 809
CHICAGO IL
60657
US

IV. Provider business mailing address

40 E HURON ST STE 304
CHICAGO IL
60611-5244
US

V. Phone/Fax

Practice location:
  • Phone: 312-761-4721
  • Fax:
Mailing address:
  • Phone: 312-788-7621
  • Fax: 312-638-0178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number071.022092
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071.022092
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071.022092
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071022092
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: