Healthcare Provider Details

I. General information

NPI: 1235906207
Provider Name (Legal Business Name): INTROSPEKT THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 SKOKIE BLVD STE 600
NORTHBROOK IL
60062-2841
US

IV. Provider business mailing address

707 SKOKIE BLVD STE 600
NORTHBROOK IL
60062-2841
US

V. Phone/Fax

Practice location:
  • Phone: 630-733-9207
  • Fax:
Mailing address:
  • Phone: 630-733-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESSICA RYAN
Title or Position: OWNER/CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 630-733-9207