Healthcare Provider Details

I. General information

NPI: 1770101420
Provider Name (Legal Business Name): ALISSA NICHOLE THOMPSON DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 W DIVERSEY AVE STE 214
CHICAGO IL
60647-7408
US

IV. Provider business mailing address

4000 W MONTROSE AVE # 618
CHICAGO IL
60641-2140
US

V. Phone/Fax

Practice location:
  • Phone: 773-257-3435
  • Fax:
Mailing address:
  • Phone: 773-257-3435
  • Fax: 331-204-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209026304
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number041434677
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: