Provider Demographics
NPI:1972855419
Name:WRIGHT, JOANNA BROOKE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:BROOKE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:J BROOKE
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1730 N CLARK ST
Mailing Address - Street 2:APT 3212
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5883
Mailing Address - Country:US
Mailing Address - Phone:630-310-4445
Mailing Address - Fax:
Practice Address - Street 1:460 N MAIN ST
Practice Address - Street 2:STE 205
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5176
Practice Address - Country:US
Practice Address - Phone:630-469-4699
Practice Address - Fax:630-469-4911
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.005057101YP2500X
IL208.000120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional