Provider Demographics
NPI:1114180148
Name:STUDIO FOR CHANGE
Entity Type:Organization
Organization Name:STUDIO FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAHN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-281-8130
Mailing Address - Street 1:2835 N SHEFFIELD AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5084
Mailing Address - Country:US
Mailing Address - Phone:773-281-8130
Mailing Address - Fax:773-281-7150
Practice Address - Street 1:2835 N SHEFFIELD AVE STE 310
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5084
Practice Address - Country:US
Practice Address - Phone:773-281-8130
Practice Address - Fax:773-281-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty