Healthcare Provider Details

I. General information

NPI: 1750191763
Provider Name (Legal Business Name): ASSEM DITCH DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 BOND ST STE 130
NAPERVILLE IL
60563-6510
US

IV. Provider business mailing address

PO BOX 56
OSWEGO IL
60543-0056
US

V. Phone/Fax

Practice location:
  • Phone: 630-859-0120
  • Fax:
Mailing address:
  • Phone: 630-859-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.032647
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: