MEDICARE: DR. JONATHAN W MURPHY PHD

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	103T00000X	Psychologist	071.010489	IL
2	103T00000X	Psychologist
3	103TC0700X	Clinical Psychologist	071.010489	IL

General Provider Information

NPI Number	:	1093232902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN W MURPHY PHD

Provider Business Mailing Address
First Line	:	1645 W JACKSON BLVD STE 602
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2847
Country	:	US
Telephone Number	:	312-942-8387
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 W JACKSON BLVD STE 602
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2847
Country	:	US
Telephone Number	:	312-942-8387
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	03/04/2022

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