=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114180148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STUDIO FOR CHANGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2008
-----------------------------------------------------
Last Update Date | 06/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2835 N SHEFFIELD AVE STE 310
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657-5084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-281-8130
-----------------------------------------------------
Fax | 773-281-7150
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2835 N SHEFFIELD AVE STE 310
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657-5084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-281-8130
-----------------------------------------------------
Fax | 773-281-7150
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JULIA M RAHN
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 773-281-8130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 071-005837
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------