Healthcare Provider Details

I. General information

NPI: 1659825586
Provider Name (Legal Business Name): ASHLEY LAINE HOUCHIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HARGER RD SUITE 600
OAK BROOK IL
60523-1805
US

IV. Provider business mailing address

1200 HARGER RD SUITE 600
OAK BROOK IL
60523-1805
US

V. Phone/Fax

Practice location:
  • Phone: 630-571-5750
  • Fax: 630-571-5751
Mailing address:
  • Phone: 630-571-5750
  • Fax: 630-571-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP 2432
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.009435
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: