Provider Demographics
NPI:1235906207
Name:INTROSPEKT THERAPY
Entity Type:Organization
Organization Name:INTROSPEKT THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-733-9207
Mailing Address - Street 1:707 SKOKIE BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2841
Mailing Address - Country:US
Mailing Address - Phone:630-733-9207
Mailing Address - Fax:
Practice Address - Street 1:707 SKOKIE BLVD STE 600
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2841
Practice Address - Country:US
Practice Address - Phone:630-733-9207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty