NPIMap

Organization Active NPI

Edgewood Clinical Services, P.C.

Doing business as LifeStance

  • Psychologist
  • Naperville, IL
National Provider Identifier
1295914646
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
EDGEWOOD CLINICAL SERVICES, P.C.
Doing business as
LifeStance
Practice address
2948 Artesian Rd Ste 112
Naperville, IL 60564-8559
Phone
(630) 428-7890
NPI assigned
Nov 1, 2007
Last updated
Mar 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ryan Pardo
Title
Chief Legal Officer
Phone
(206) 399-1493

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 149-010253 IL
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Behavioral Neurology & Neuropsychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084B0040X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

2948 Artesian Rd Ste 112
Naperville, IL 60564-8559

Mailing address

4800 N Scottsdale Rd Ste 2500
Scottsdale, AZ 85251-7630
Phone (480) 524-0990

Other names 1

  • LifeStance Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230721001228 IL Part B Supplier - Clinic/Group Practice 3971963901 Receives reassigned benefits from 445 practitioners
Practice locations: Oswego, IL; Lake in the Hills, IL; Orland Park, IL; Oblong, IL; Oak Park, IL; Northbrook, IL; Naperville, IL; Lockport, IL…

National Provider Directory

National Provider Directory

Locations (25 of 37)

2124 Ogden Ave
Ste 301
Aurora, IL 60504
Phone (630) 328-0111

2406 E Empire St
Fl 4
Bloomington, IL 61704

755 Almar Pkwy
Bourbonnais, IL 60914
Phone (779) 229-6581

2506 Galen Dr
Ste 101
Champaign, IL 61821
Phone (217) 693-6072

1 E Erie St
Ste 520
Chicago, IL 60611
Phone (312) 761-4726

1616 N Damen Ave
Ste 301
Chicago, IL 60647
Phone (888) 926-3251

2845 N Sheridan Rd
Ste 809
Chicago, IL 60657
Phone (312) 761-4721

3976 N Avondale Ave
Fl 2
Chicago, IL 60641
Phone (312) 319-4162

500 N Michigan Ave
Ste 1400
Chicago, IL 60611
Phone (312) 761-4755

7900 Cass Ave
Ste 200
Darien, IL 60561
Phone (630) 884-8643

102 W Kenwood Ave
Ste 120
Decatur, IL 62526
Phone (217) 520-1047

180 W Park Ave
Ste 150
Elmhurst, IL 60126
Phone (630) 235-8089

1007 Church St
Ste 312
Evanston, IL 60201
Phone (844) 215-4468

28 N 1st St
Geneva, IL 60134

28 N 1st St
Ste 201
Geneva, IL 60134
Phone (561) 386-9465

1790 Nations Dr
Ste 213
Gurnee, IL 60031

581 Elm Pl
Ste 110
Highland Park, IL 60035
Phone (847) 861-7771

120 E Ogden Ave
Ste 11
Hinsdale, IL 60521

901 N Elm St
Ste 275
Hinsdale, IL 60521
Phone (331) 529-8712

1500 Eisenhower Ln
Unit E
Lisle, IL 60532

16221 W 159th St
Ste 102
Lockport, IL 60441
Phone (708) 906-9349

1717 N Naper Blvd
Ste 109
Naperville, IL 60563

3027 English Rows Ave
Ste 201
Naperville, IL 60564

55 S Main St
Ste 252
Naperville, IL 60540
Phone (630) 238-0949

900 E Diehl Rd
Ste 101
Naperville, IL 60563
Phone (630) 328-0134

Practitioners & affiliated clinicians

Practitioners 643

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 643

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1295914646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N SCOTTSDALE RD STE 2500",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852517630",
            "telephone_number": "480-524-0990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2948 ARTESIAN RD STE 112",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605648559",
            "telephone_number": "630-428-7890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD CLINICAL SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-01",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A",
        "authorized_official_last_name": "PARDO",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CHIEF LEGAL OFFICER",
        "authorized_official_telephone_number": "206-399-1493"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149-010253",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeStance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Naperville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.