Healthcare Provider Details

I. General information

NPI: 1386618668
Provider Name (Legal Business Name): JERRY S SCHECTER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 CRAWFORD AVE #105
SKOKIE IL
60076-1700
US

IV. Provider business mailing address

4532 S SEMINOLE DR
GLENVIEW IL
60026-7306
US

V. Phone/Fax

Practice location:
  • Phone: 847-679-5243
  • Fax: 847-753-9592
Mailing address:
  • Phone: 847-679-5243
  • Fax: 847-753-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1031731
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: