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NPI Code Detail

MEDICARE: CHICAGO CENTER FOR GROWTH AND CHANGE, LLC

MEDICARE: CHICAGO CENTER FOR GROWTH AND CHANGE, 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
1103TC0700XClinical Psychologist071008093IL

General Provider Information

NPI Number : 1255793360
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHICAGO CENTER FOR GROWTH AND CHANGE, LLC
Provider Business Mailing Address
First Line : 5246 W CARMEN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-2211
Country : US
Telephone Number : 312-566-8536
Fax Number : 888-416-1729
Provider Business Practice Location Address
First Line : 25 E WASHINGTON ST STE 1717
Second Line :
City : CHICAGO
State : IL
Zip : 60602-1839
Country : US
Telephone Number : 312-566-8536
Fax Number :
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : DR. JODIE ERIN SINGER
Credential : PSY.D., M.A.
Telephone Number : 312-566-8536
Provider Enumeration Date : 03/28/2016
Last Update Date : 07/21/2023

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