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NPI Code Detail

MEDICARE: JENNIFER DIAMOND PHD, PLLC

MEDICARE: JENNIFER DIAMOND PHD, 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 : 1821621962
Entity Type Code : Organization
Provider Name (Legal Business Name) : JENNIFER DIAMOND PHD, PLLC
Provider Business Mailing Address
First Line : 910 W ARMITAGE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-4204
Country : US
Telephone Number : 312-802-9876
Fax Number :
Provider Business Practice Location Address
First Line : 939 W NORTH AVE STE 750
Second Line :
City : CHICAGO
State : IL
Zip : 60642-7142
Country : US
Telephone Number : 262-885-1977
Fax Number :
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : DR. JENNIFER DIAMOND
Credential : PHD
Telephone Number : 312-802-9876
Provider Enumeration Date : 02/18/2020
Last Update Date : 05/06/2024

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