Alexis Ivy Abern
Individual provider Active NPI Clinical Psychologist · Northfield, IL
NPI 1588064034 · NPPES record last updated Jul 23, 2019
Key facts
- NPI
- 1588064034
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 071.010063 (IL)
- Practice address
- 405 Central Ave
Northfield, IL 60093-3006 - Phone
- (847) 441-5600
- NPI assigned
- Sep 2, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.010063 | IL | MD | Clinical Psychologist |
| A165-0099-0735 | IL | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Tree House Center for Growth and Learning | Clinical | Past | Accepting new patients |
| Caravel Autism Health, LLC | Clinical | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | A165-0099-0735 | IL | |
| Clinical Psychologist | 103TC0700X | 071.010063 | IL | Yes |
Addresses
Primary practice location
405 Central Ave
Northfield, IL 60093-3006
Mailing address
405 Central Ave
Northfield, IL 60093-3006
Phone (847) 441-5600
Other providers in Northfield, IL
- 1918 Winter Street Operating Co LLC
- Najma M Adam
- Lindsay Adams
- Thomas J Adams
- Elissah Fay Adkins
- Advanced Neurological Associates SC
All providers in Northfield, IL · Clinical Psychologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.