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General NPI Number Information
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NPI Number | 1437578044
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Entity Type | Individual
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Provider Name | JASON RYAN SOBLE PH.D., ABPP
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Gender | Male
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 912 S WOOD ST # MC913
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City | CHICAGO
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State | IL
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Zip | 60612-4300
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Country | US
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Telephone | 312-996-6217
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Fax |
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Provider Business Mailing Address
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Address Line | UNIVERSITY OF ILLINOIS AT CHICAGO-DEPT. OF PSYCHIATRY 912 S. WOOD STREET, MC 913
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City | CHICAGO
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State | IL
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Zip | 60612-4300
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Country | US
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Telephone | 312-996-6217
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 071.009609
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 071.009609
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License Number State | IL
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