NPIMap

Organization Active NPI

Bucktown Therapy

  • Community/Behavioral Health Agency
  • Chicago, IL
National Provider Identifier
1962032086
Registry record updated Jan 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
BUCKTOWN THERAPY
Practice address
1820 W Webster Ave Ste 200
Chicago, IL 60614-2934
Phone
(630) 733-8595
NPI assigned
Jan 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2020

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

Authorized official

Name
Kristin Ridder, PHDNPI 1134764400
Title
Clinical Psychologist
Phone
(920) 418-1165

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1820 W Webster Ave Ste 200
Chicago, IL 60614-2934

Mailing address

3125 W Fullerton Ave Apt 212
Chicago, IL 60647-6959
Phone (920) 418-1165

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1579132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579132800000",
    "number": "1962032086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3125 W FULLERTON AVE APT 212",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606476959",
            "telephone_number": "920-418-1165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 W WEBSTER AVE STE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606142934",
            "telephone_number": "630-733-8595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCKTOWN THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-16",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A",
        "authorized_official_last_name": "RIDDER",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "920-418-1165",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "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 Jan 16, 2020; 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.