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NPI Code Detail

MEDICARE: CHICAGO THERAPY AND ASSESSMENT SERVICES, LLC

MEDICARE: CHICAGO THERAPY AND ASSESSMENT SERVICES, 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 Psychologist170.009205IL

General Provider Information

NPI Number : 1982100921
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHICAGO THERAPY AND ASSESSMENT SERVICES, LLC
Provider Business Mailing Address
First Line : 150 S WACKER DR STE 2400
Second Line :
City : CHICAGO
State : IL
Zip : 60606-4211
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 150 S WACKER DR STE 2400
Second Line :
City : CHICAGO
State : IL
Zip : 60606-4211
Country : US
Telephone Number : 312-798-9078
Fax Number :
Authorized Official
Title or Position : LICENSED CLINICAL PSYCHOLOGIST
Name : DR. STACEY WILLARD
Credential : PSYD
Telephone Number : 312-798-9078
Provider Enumeration Date : 03/30/2018
Last Update Date : 03/30/2018

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Directions to “CHICAGO THERAPY AND ASSESSMENT SERVICES, LLC ” Practice Location

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