Healthcare Provider Details

I. General information

NPI: 1508720988
Provider Name (Legal Business Name): CONVISER GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 LONGMEADOW LN
GLENCOE IL
60022-1064
US

IV. Provider business mailing address

1161 LONGMEADOW LN
GLENCOE IL
60022-1064
US

V. Phone/Fax

Practice location:
  • Phone: 773-551-7746
  • Fax:
Mailing address:
  • Phone: 773-551-7746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JENNY CONVISER
Title or Position: CEO
Credential:
Phone: 773-551-7746