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General NPI Number Information
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NPI Number | 1063878833
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Entity Type | Organization
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Legal Business Name | DR. JESSICA RANSOM AND ASSOCIATES LLC
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 4043 N RAVENSWOOD AVE 227
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City | CHICAGO
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State | IL
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Zip | 60613-1155
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Country | US
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Telephone | 773-800-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 4043 N RAVENSWOOD AVE 227
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City | CHICAGO
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State | IL
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Zip | 60613-1155
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/OWNER
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Name | DR. JESSICA RANSOM
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Credential |
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Telephone | 773-800-1510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071007126
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License Number State | IL
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