Healthcare Provider Details

I. General information

NPI: 1821969841
Provider Name (Legal Business Name): RICARDO PONCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON ST STE 100
WEST DUNDEE IL
60118-1275
US

IV. Provider business mailing address

1482 JOSHEL CT
GENEVA IL
60134-3702
US

V. Phone/Fax

Practice location:
  • Phone: 630-715-2042
  • Fax:
Mailing address:
  • Phone: 630-715-2042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: