Provider Demographics
NPI:1679198055
Name:DITCHEK PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:DITCHEK PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DITCHEK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-390-0800
Mailing Address - Street 1:1580 N NORTHWEST HWY STE 228E
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1468
Mailing Address - Country:US
Mailing Address - Phone:847-390-0800
Mailing Address - Fax:
Practice Address - Street 1:1580 N NORTHWEST HWY STE 228E
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1468
Practice Address - Country:US
Practice Address - Phone:847-390-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty