Provider Demographics
NPI:1295953115
Name:RATKOWSKI, JOANNE A (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:A
Last Name:RATKOWSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 N NOBLE ST
Mailing Address - Street 2:#2N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3377
Mailing Address - Country:US
Mailing Address - Phone:773-720-2781
Mailing Address - Fax:
Practice Address - Street 1:5015 N PAULINA
Practice Address - Street 2:STE 310
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-271-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71006837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK15917Medicare ID - Type Unspecified