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NPI Code Detail

MEDICARE: INDIVISIBLE PSYCHOLOGY PLLC

MEDICARE: INDIVISIBLE PSYCHOLOGY PLLC
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 Psychologist

General Provider Information

NPI Number : 1720947831
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDIVISIBLE PSYCHOLOGY PLLC
Provider Business Mailing Address
First Line : 5215 N RAVENSWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1668
Country : US
Telephone Number : 872-205-9931
Fax Number :
Provider Business Practice Location Address
First Line : 5215 N RAVENSWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1668
Country : US
Telephone Number : 872-205-9931
Fax Number :
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : DR. SHAWNA BROUGH
Credential : PSYD
Telephone Number : 872-205-9931
Provider Enumeration Date : 01/15/2026
Last Update Date : 01/15/2026

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Directions to “INDIVISIBLE PSYCHOLOGY PLLC ” Practice Location

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