=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154700813
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REEMA OBAID ROSS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2015
-----------------------------------------------------
Last Update Date | 05/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 MERCHANDISE MART PLZ SUITE 4121
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60654-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-771-0625
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 N LAKE SHORE DR UNIT 3903
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-3427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-771-0625
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. REEMA OBAID ROSS
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 219-771-0625
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 071008537
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------