Provider Demographics
NPI:1114543931
Name:RANGASWAMI, ADYA
Entity Type:Individual
Prefix:
First Name:ADYA
Middle Name:
Last Name:RANGASWAMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W MADISON ST STE 702
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4671
Mailing Address - Country:US
Mailing Address - Phone:312-880-9913
Mailing Address - Fax:
Practice Address - Street 1:105 W MADISON ST STE 702
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4671
Practice Address - Country:US
Practice Address - Phone:312-880-9913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178017973101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health