Healthcare Provider Details

I. General information

NPI: 1295445328
Provider Name (Legal Business Name): CHRISTINE OCKRASSA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 WINDHAM PKWY
ROMEOVILLE IL
60446-1608
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 815-942-6363
  • Fax:
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071-010943
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: