Provider Demographics
NPI:1457641730
Name:FLETCHER, ALLISON (PSYD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N WABASH AVE UNIT 4507
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5688
Mailing Address - Country:US
Mailing Address - Phone:773-203-3727
Mailing Address - Fax:866-441-1136
Practice Address - Street 1:405 N WABASH AVE UNIT 4507
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5688
Practice Address - Country:US
Practice Address - Phone:773-203-3727
Practice Address - Fax:866-441-1136
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL071008761103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program