Individual provider Active NPI

Christine Anne Lee, PHD

  • Psychologist
  • Chicago, IL
National Provider Identifier
1952806937
Registry record updated May 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
071.010752 Issued in IL
Practice address
1747 W Roosevelt Rd
Chicago, IL 60608-1264
Phone
(312) 996-7723
NPI assigned
Mar 29, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X IL
Student in an Organized Health Care Education/Training Program 390200000X
Psychologist 103T00000X 071.010752 IL Primary

Addresses

Primary practice location

1747 W Roosevelt Rd
Chicago, IL 60608-1264

Mailing address

1747 W Roosevelt Rd
Chicago, IL 60608-1264
Phone (312) 996-7723

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220927001954 IL Practitioner - Clinical Psychologist 9739593757 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
071.010752ILMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois Psychologist CurrentSince Jun 16, 2022 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Jun 16, 2022 Accepting new patients
The Board of Trustees of the University of Illinois Past Accepting new patients

Locations

912 S Wood St
Chicago, IL 60612
Phone (312) 996-2200

835 S Wolcott Ave
Rm W140
Chicago, IL 60612

7825 Solution Ctr
Chicago, IL 60677

1747 W Roosevelt Rd
Chicago, IL 60608
Phone (312) 996-2200

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1522281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1952806937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1747 W ROOSEVELT RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081264",
            "telephone_number": "312-996-7723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1747 W ROOSEVELT RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081264",
            "telephone_number": "312-996-7723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "CHRISTINE",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-29",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071.010752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.