MEDICARE: DR. JESSICA RANSOM AND ASSOCIATES LLC

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	103TF0200X	Forensic Psychologist
2	103TC0700X	Clinical Psychologist	071007126	IL

General Provider Information

NPI Number	:	1063878833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JESSICA RANSOM AND ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	4043 N RAVENSWOOD AVE
Second Line	:	227
City	:	CHICAGO
State	:	IL
Zip	:	60613-1155
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4043 N RAVENSWOOD AVE
Second Line	:	227
City	:	CHICAGO
State	:	IL
Zip	:	60613-1155
Country	:	US
Telephone Number	:	773-800-1510
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST/OWNER
Name	:	DR. JESSICA RANSOM
Credential	:
Telephone Number	:	773-800-1510

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	01/11/2016

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