Healthcare Provider Details

I. General information

NPI: 1851412456
Provider Name (Legal Business Name): ALEXIS LYBROOK TAUBERT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 S MICHIGAN AVE APT 1309
CHICAGO IL
60605-3402
US

IV. Provider business mailing address

1305 S MICHIGAN AVE APT 1309
CHICAGO IL
60605-3402
US

V. Phone/Fax

Practice location:
  • Phone: 312-415-7304
  • Fax:
Mailing address:
  • Phone: 312-415-7304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number071002542
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071002542
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: