Healthcare Provider Details

I. General information

NPI: 1700251519
Provider Name (Legal Business Name): OKOON PSYCHOLOGY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 PATRIOT BLVD STE 240
GLENVIEW IL
60026-8021
US

IV. Provider business mailing address

2700 PATRIOT BLVD STE 240
GLENVIEW IL
60026-8021
US

V. Phone/Fax

Practice location:
  • Phone: 847-729-5510
  • Fax: 847-729-5512
Mailing address:
  • Phone: 847-729-5510
  • Fax: 847-729-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071006294
License Number StateIL

VIII. Authorized Official

Name: JEFFREY O'KOON
Title or Position: DIRECTOR
Credential: PH.D
Phone: 847-729-5510