Provider Demographics
NPI:1609927045
Name:DENISE LEGACKI TOMPKINS, PSY.D. & ASSOC. LTD.
Entity Type:Organization
Organization Name:DENISE LEGACKI TOMPKINS, PSY.D. & ASSOC. LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:LEGACKI
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-717-5911
Mailing Address - Street 1:1801 N MILL ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1274
Mailing Address - Country:US
Mailing Address - Phone:630-717-5911
Mailing Address - Fax:630-717-9140
Practice Address - Street 1:1801 N MILL ST
Practice Address - Street 2:SUITE C
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1274
Practice Address - Country:US
Practice Address - Phone:630-717-5911
Practice Address - Fax:630-717-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-14
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71006304103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232064OtherBLUE CROSS PROVIDER NUMBE
IL200906Medicare ID - Type Unspecified