MEDICARE: DR. JEAN MARIE GRIFFIN PHD

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	103G00000X	Clinical Neuropsychologist	071004509	IL
2	103TR0400X	Rehabilitation Psychologist	071004509	IL
3	103TC0700X	Clinical Psychologist	071004509	IL

General Provider Information

NPI Number	:	1871530659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN MARIE GRIFFIN PHD

Provider Business Mailing Address
First Line	:	5008 PRATT AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-3513
Country	:	US
Telephone Number	:	773-680-2244
Fax Number	:

Provider Business Practice Location Address
First Line	:	5225 OLD ORCHARD RD STE 32
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-1027
Country	:	US
Telephone Number	:	773-680-2244
Fax Number	:	847-470-0741

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	04/15/2019

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