Healthcare Provider Details

I. General information

NPI: 1760516660
Provider Name (Legal Business Name): STEPHANIE A ROSS LICENSED CLINICAL PSYCHOLOGIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 W LAKE AVE SUITE 400
GLENVIEW IL
60026-5805
US

IV. Provider business mailing address

3633 W LAKE AVE SUITE 400
GLENVIEW IL
60026-5805
US

V. Phone/Fax

Practice location:
  • Phone: 773-459-6756
  • Fax: 773-728-8719
Mailing address:
  • Phone: 773-459-6756
  • Fax: 773-728-8719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. STEPHANIE A ROSS
Title or Position: OWNED
Credential: PHD
Phone: 773-459-6756