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General NPI Number Information
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NPI Number | 1255793360
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Entity Type | Organization
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Legal Business Name | CHICAGO CENTER FOR GROWTH AND CHANGE, LLC
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 07/21/2023
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST STE 1717
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City | CHICAGO
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State | IL
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Zip | 60602-1839
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Country | US
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Telephone | 312-566-8536
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Fax |
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Provider Business Mailing Address
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Address Line | 5246 W CARMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60630-2211
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Country | US
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Telephone | 312-566-8536
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Fax | 888-416-1729
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JODIE ERIN SINGER
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Credential | PSY.D., M.A.
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Telephone | 312-566-8536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071008093
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License Number State | IL
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