MEDICARE: SPRINGSOURCE PSYCHOLOGICAL CENTER PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1033735550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGSOURCE PSYCHOLOGICAL CENTER PLLC

Provider Business Mailing Address
First Line	:	1770 HARRISON ST
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-5065
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 W JACKSON BLVD STE 520
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-3433
Country	:	US
Telephone Number	:	224-202-6260
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	SUSAN FOTI MCCLANAHAN
Credential	:	PH.D.
Telephone Number	:	312-337-6064

Provider Enumeration Date	:	06/20/2020
Last Update Date	:	03/06/2026

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