Provider Demographics
NPI:1285863480
Name:PYYKKONEN, BENJAMIN AARON (PHD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:AARON
Last Name:PYYKKONEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1358 SANDCHERRY LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-5973
Mailing Address - Country:US
Mailing Address - Phone:630-699-7499
Mailing Address - Fax:
Practice Address - Street 1:1700 LINCOLN HWY STE J
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3575
Practice Address - Country:US
Practice Address - Phone:331-707-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007708103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871149781OtherINDIVIDUAL NPI