| Jon-paul Champine, Psy.d., P.c. | |
|
2530 Crawford Ave Suite 315 Evanston IL 60201-4970 | |
| (847) 869-4650 | |
| (773) 751-2250 |
| Full Name | Jon-paul Champine, Psy.d., P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 2530 Crawford Ave, Evanston, Illinois |
| Authorized Official Name and Position | Jon-paul Champine (PRESIDENT) |
| Authorized Official Contact | 8478694650 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jon-paul Champine, Psy.d., P.c. 2530 Crawford Ave Suite 315 Evanston IL 60201-4970 Ph: (847) 869-4650 | Jon-paul Champine, Psy.d., P.c. 2530 Crawford Ave Suite 315 Evanston IL 60201-4970 Ph: (847) 869-4650 |
| NPI Number | 1629377882 |
|---|---|
| Provider Enumeration Date | 03/26/2011 |
| Last Update Date | 03/26/2011 |
| Medicare PECOS PAC ID | 0345427225 |
|---|---|
| Medicare Enrollment ID | O20110601000403 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629377882 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071006739 (Illinois) | Primary |
| Provider Name | Jon Paul Champine |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982698833 PECOS PAC ID: 2860452182 Enrollment ID: I20041012000887 |
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