MEDICARE: DR. JEFFERY GARRISON JR. PSY.D

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	071011457	IL
2	103G00000X	Clinical Neuropsychologist	071011457	IL
3	103T00000X	Psychologist	071011457	IL
4	103TC0700X	Clinical Psychologist	071011457	IL

General Provider Information

NPI Number	:	1447954896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY GARRISON JR. PSY.D

Provider Business Mailing Address
First Line	:	40 E HURON ST STE 304
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-5244
Country	:	US
Telephone Number	:	312-788-7621
Fax Number	:	312-638-0178

Provider Business Practice Location Address
First Line	:	40 E HURON ST STE 304
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-5244
Country	:	US
Telephone Number	:	312-788-7621
Fax Number	:	312-638-0178

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

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	12/18/2025

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