| Modify, P.c. | |
|
2272 95th St Ste 305 Naperville IL 60564-8944 | |
| (630) 753-9800 | |
| (630) 753-9798 |
| Full Name | Modify, P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 2272 95th St Ste 305, Naperville, Illinois |
| Authorized Official Name and Position | Lisa Mary Busch (OWNER, CEO) |
| Authorized Official Contact | 6307539800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Modify, P.c. 2272 95th St Ste 305 Naperville IL 60564-8944 Ph: (630) 753-9800 | Modify, P.c. 2272 95th St Ste 305 Naperville IL 60564-8944 Ph: (630) 753-9800 |
| NPI Number | 1457479503 |
|---|---|
| Provider Enumeration Date | 03/27/2007 |
| Last Update Date | 07/12/2019 |
| Medicare PECOS PAC ID | 8628355963 |
|---|---|
| Medicare Enrollment ID | O20170515001583 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457479503 | NPI | - | NPPES |
| 09923724 | Other | IL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | 071005399 (Illinois) | Primary |
| Provider Name | Gerald D Lawm |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821284423 PECOS PAC ID: 8820035173 Enrollment ID: I20050408000606 |
| Provider Name | Lisa M Busch |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235325978 PECOS PAC ID: 1658529201 Enrollment ID: I20170515001607 |
| Provider Name | Thea Angel Myers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952869893 PECOS PAC ID: 4981096138 Enrollment ID: I20220119002886 |
| Provider Name | Kevin T Wolter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487170551 PECOS PAC ID: 8527445618 Enrollment ID: I20220511000090 |
| Provider Name | Brian J Page |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073971396 PECOS PAC ID: 2769837970 Enrollment ID: I20231009000764 |
| Provider Name | Heather E Ranneklev |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609638287 PECOS PAC ID: 2365889227 Enrollment ID: I20240327001893 |
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