1881616969 NPI number — CLAIREIVY GAYLE KUMCHY PH.D. CLINICAL PSYCH

Table of content: CLAIREIVY GAYLE KUMCHY PH.D. CLINICAL PSYCH (NPI 1881616969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881616969 NPI number — CLAIREIVY GAYLE KUMCHY PH.D. CLINICAL PSYCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUMCHY
Provider First Name:
CLAIREIVY
Provider Middle Name:
GAYLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D. CLINICAL PSYCH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881616969
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 N LAKEVIEW AVE
Provider Second Line Business Mailing Address:
806
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60614-2747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-929-7860
Provider Business Mailing Address Fax Number:
773-829-4433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 N LAKEVIEW AVE
Provider Second Line Business Practice Location Address:
806
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60614-2747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-929-7860
Provider Business Practice Location Address Fax Number:
773-829-4433
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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