Individual provider Active NPI

Courtenay Rourke Ainsworth, PH.D.

  • Clinical Neuropsychologist
  • Chicago, IL
National Provider Identifier
1306109244
Registry record updated Jun 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
071.008330 Issued in IL
Practice address
4726 N Winchester Ave
Unit B
Chicago, IL 60640-4372
Phone
(708) 609-7475
NPI assigned
Jun 15, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 071.008330 IL Primary

Addresses

Primary practice location

4726 N Winchester Ave
Unit B
Chicago, IL 60640-4372

Mailing address

4726 N Winchester Ave
Unit B
Chicago, IL 60640-4372
Phone (708) 609-7475

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
071.008330ILMDClinical Neuropsychologist

NPI Registry JSON

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

{
    "created_epoch": "1339718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339718400000",
    "number": "1306109244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4726 N WINCHESTER AVE",
            "address_2": "UNIT B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404372",
            "telephone_number": "708-609-7475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4726 N WINCHESTER AVE",
            "address_2": "UNIT B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404372",
            "telephone_number": "708-609-7475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AINSWORTH",
        "first_name": "COURTENAY",
        "middle_name": "ROURKE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-15",
        "last_updated": "2012-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": "071.008330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.