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General NPI Number Information
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NPI Number | 1104164128
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Entity Type | Organization
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Legal Business Name | FANCHER PSYCHOLOGY AND ASSESSMENT, LLC
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Dates
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Enumeration Date | 01/25/2013
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 4711 GOLF RD STE 414
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City | SKOKIE
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State | IL
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Zip | 60076-1242
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Country | US
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Telephone | 312-854-9764
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Fax |
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Provider Business Mailing Address
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Address Line | 4711 GOLF RD STE 414
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City | SKOKIE
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State | IL
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Zip | 60076-1242
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Country | US
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Telephone | 312-854-9764
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. RACHEL RILEY FANCHER
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Credential | PSY.D.
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Telephone | 312-854-9764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071008207
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License Number State | IL
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