Healthcare Provider Details

I. General information

NPI: 1225542848
Provider Name (Legal Business Name): SAPPHO RISNER NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAPPHO RISNER LUTER NCSP

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 WILLIAM ST APT 2E
RIVER FOREST IL
60305-1152
US

IV. Provider business mailing address

1533 WILLIAM ST APT 2E
RIVER FOREST IL
60305-1152
US

V. Phone/Fax

Practice location:
  • Phone: 773-383-5763
  • Fax:
Mailing address:
  • Phone: 773-383-5763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: