Provider Demographics
NPI:1225542848
Name:RISNER, SAPPHO (NCSP)
Entity Type:Individual
Prefix:
First Name:SAPPHO
Middle Name:
Last Name:RISNER
Suffix:
Gender:F
Credentials:NCSP
Other - Prefix:
Other - First Name:SAPPHO
Other - Middle Name:RISNER
Other - Last Name:LUTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NCSP
Mailing Address - Street 1:1533 WILLIAM ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1152
Mailing Address - Country:US
Mailing Address - Phone:773-383-5763
Mailing Address - Fax:
Practice Address - Street 1:1533 WILLIAM ST APT 2E
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1152
Practice Address - Country:US
Practice Address - Phone:773-383-5763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool