Provider Demographics
NPI:1982650263
Name:CIMO, JOANN DAKOTA (PHD CLINICAL PSYCHOL)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:DAKOTA
Last Name:CIMO
Suffix:
Gender:F
Credentials:PHD CLINICAL PSYCHOL
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:B
Other - Last Name:CIMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3850 N LAWNDALE AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618
Mailing Address - Country:US
Mailing Address - Phone:773-539-9183
Mailing Address - Fax:773-509-0874
Practice Address - Street 1:3850 N LAWNDALE AVE
Practice Address - Street 2:STE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618
Practice Address - Country:US
Practice Address - Phone:773-539-9183
Practice Address - Fax:773-509-0874
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634692OtherBCBS
211059Medicare ID - Type Unspecified