Provider Demographics
NPI:1528357415
Name:JAMES R IBERG
Entity Type:Organization
Organization Name:JAMES R IBERG
Other - Org Name:EMPATHYWORK AFFILIATED SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:IBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-864-0303
Mailing Address - Street 1:2009 MCDANIEL AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2124
Mailing Address - Country:US
Mailing Address - Phone:847-864-0303
Mailing Address - Fax:847-475-5111
Practice Address - Street 1:180 N MICHIGAN AVE
Practice Address - Street 2:SUITE 2404
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7401
Practice Address - Country:US
Practice Address - Phone:847-864-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.002641103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty