Healthcare Provider Details

I. General information

NPI: 1013898873
Provider Name (Legal Business Name): PARIS JETAUN BALL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE STE G155
EVANSTON IL
60201-1700
US

IV. Provider business mailing address

160 N ELIZABETH ST APT 2412
CHICAGO IL
60607-1678
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-1600
  • Fax: 847-733-5640
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008971
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: