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General NPI Number Information
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NPI Number | 1851049878
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Entity Type | Individual
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Provider Name | BENJAMIN PARCHEM PHD
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Gender | Male
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 1440 N DAYTON ST
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City | CHICAGO
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State | IL
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Zip | 60642-2644
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Country | US
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Telephone | 312-227-5096
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Fax |
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Provider Business Mailing Address
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Address Line | N74W24606 MERSKE CT
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City | SUSSEX
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State | WI
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Zip | 53089-4714
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Country | US
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Telephone |
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | LP6986
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 071.011245
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License Number State | IL
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