Healthcare Provider Details

I. General information

NPI: 1649642125
Provider Name (Legal Business Name): MISHEL RYCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 BAY SCOTT CIR SUITE 105
NAPERVILLE IL
60540-1114
US

IV. Provider business mailing address

1831 BAY SCOTT CIR SUITE 105
NAPERVILLE IL
60540-1114
US

V. Phone/Fax

Practice location:
  • Phone: 630-305-0464
  • Fax: 630-305-0211
Mailing address:
  • Phone: 630-305-0464
  • Fax: 630-305-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.017602
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: