Healthcare Provider Details

I. General information

NPI: 1245921535
Provider Name (Legal Business Name): VICTORIA VISSCHER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N OAK PARK AVE FL 2
OAK PARK IL
60301-1364
US

IV. Provider business mailing address

105 N OAK PARK AVE FL 2
OAK PARK IL
60301-1364
US

V. Phone/Fax

Practice location:
  • Phone: 630-480-6934
  • Fax:
Mailing address:
  • Phone: 630-480-6934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.010938
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: