MEDICARE: SAPPHO RISNER NCSP

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1225542848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAPPHO RISNER NCSP

Provider Business Mailing Address
First Line	:	1533 WILLIAM ST APT 2E
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1152
Country	:	US
Telephone Number	:	773-383-5763
Fax Number	:

Provider Business Practice Location Address
First Line	:	1533 WILLIAM ST APT 2E
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1152
Country	:	US
Telephone Number	:	773-383-5763
Fax Number	:

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

Provider Enumeration Date	:	11/17/2017
Last Update Date	:	11/17/2017

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Directions to “ SAPPHO RISNER NCSP” Practice Location

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