A DRAGONFLY MIND, LLC (NPI# 1730623729) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730623729 |
| Entity Type | Organization |
| Organization Name | A DRAGONFLY MIND, LLC |
| Practice Address |
4801 W Peterson Ave Suite 301 Chicago IL 60646-5726 |
| Mailing Address |
130 Main St Apt 2 Evanston IL 60202-5425 |
| Practice Telephone | 7736698378 |
| Practice Fax Number | 8889772162 |
| Mailing Telephone | 7736698378 |
| Mailing Fax Number | 8889772162 |
| Enumeration Date | 2016-12-09 |
| Last Update Date | 2017-04-12 |
| Authorized Official Name | MARCIA ZUMBAHLEN (FOUNDER) |
| Authorized Official Telephone | 7736698378 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103G00000X | Clinical Neuropsychologist | 082604 | IA | Behavioral Health & Social Service Providers |
| Y | 103G00000X | Clinical Neuropsychologist | 071009422 | IL | Behavioral Health & Social Service Providers |
| Street Address |
4801 W PETERSON AVE SUITE 301 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60646-5726 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588667315 | Barry M Leavitt | Psychologist | 4801 W Peterson Ave, Ste 525, Chicago, IL 60646 | 2005-05-24 |
| 1790229441 | Valerie Deutsch | Behavioral Analyst | 4801 W Peterson Ave, Suite 512, Chicago, IL 60646-5713 | 2016-12-15 |
| 1760938260 | Catherine Bogacki | Social Worker | 4801 W Peterson Ave, Suite 308, Chicago, IL 60646-5713 | 2016-08-25 |
| 1841662434 | Paul Robert Muhr | Dentist | 4801 W Peterson Ave, Suite 407, Chicago, IL 60646-5713 | 2015-10-22 |
| 1548631245 | Amy Derusha | Behavioral Analyst | 4801 W Peterson Ave, 512, Chicago, IL 60646-5713 | 2015-10-07 |
| 1063818813 | Amalia Pepek | Nurse Practitioner | 4801 W Peterson Ave, Suite 506, Chicago, IL 60646-5713 | 2014-11-06 |
| 1689089286 | Roxanne Gayle | Behavioral Analyst | 4801 W Peterson Ave, #512, Chicago, IL 60646-5713 | 2014-06-23 |
| 1982018461 | Superior Rehab Center LLC | Physical Therapist | 4801 W Peterson Ave, 615, Chicago, IL 60646-5713 | 2014-06-12 |
| 1720415367 | Frank J Gutierrez | Counselor | 4801 W Peterson Ave, Suite 403, Chicago, IL 60646 | 2013-09-27 |
| 1487092177 | Lauren Verrilli | Physical Therapist | 4801 W Peterson Ave, Suite 314, Chicago, IL 60646-5713 | 2013-06-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801312087 | Manal Ibrahim | Dentist | 6228 N Keystone Ave, Chicago, IL 60646 | 2017-08-18 |
| 1750820742 | Kaitlin O'brien | Student in an Organized Health Care Education/Training Program | 5801 N Pulaski, Chicago, IL 60646 | 2017-02-23 |
| 1659810646 | Sofia Trani | Student in an Organized Health Care Education/Training Program | 5801 N. Pulaski Rd, Chicago, IL 60646 | 2017-02-23 |
| 1487191151 | Ronald E. Rysztogi | Naprapath | 5704 N. Austin, Chicago, IL 60646 | 2017-01-19 |
| 1417403148 | Joyful Dental Care | Clinic/Center | 6314 N. Cicero Avenue, Chicago, IL 60646 | 2016-09-01 |
| 1164889754 | Physicians At Call | Family Medicine | 5901 N. Cicero Ave, Ste 207, Chicago, IL 60646 | 2016-01-27 |
| 1245610617 | Arlett Payne | Physician Assistant | 5906 N Milwaukee, Chicago, IL 60646 | 2015-06-01 |
| 1811375843 | North River Mental Health Center | Community/Behavioral Health | 5801 North Pulaski Road, Chicago, IL 60646 | 2015-05-11 |
| 1003157298 | Family Choice Home Health | Homemaker | 5933 N Milwaukee Avenue, Chicago, IL 60646 | 2013-03-13 |
| 1235479593 | Antonina Skapars Trinkuns | Psychiatry & Neurology | 6404 N. Tahoma Ave., Chicago, IL 60646 | 2013-02-25 |
| Find all providers in zip 60646 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649830159 | Natalie Berger | Clinical Neuropsychologist | 1645 W Jackson Blvd Ste 203, Chicago, IL 60612-3227 | 2019-06-17 |
| 1225575871 | Israel Gross | Clinical Neuropsychologist | 1934 W. Roscoe St., #4, Chicago, IL 60657 | 2017-01-20 |
| 1144680703 | Brenda Henderson | Clinical Neuropsychologist | 7958 S Michigan Ave, Chicago, IL 60619-3509 | 2016-02-25 |
| 1386002871 | Karen Rottier | Clinical Neuropsychologist | 1539 W Oakdale Ave, Chicago, IL 60657-4010 | 2016-01-29 |
| 1952784589 | Jana Wingo | Clinical Neuropsychologist | 320 E Superior St, Chicago, IL 60611-3010 | 2015-07-01 |
| 1275947236 | Mattthew Paul Richmond | Clinical Neuropsychologist | 33 N Dearborn St Ste 1600, C/o Dr. Matthew Richmond, Chicago, IL 60602-3102 | 2014-06-18 |
| 1437578044 | Jason Ryan Soble | Clinical Neuropsychologist | 912 S Wood St # Mc913, Chicago, IL 60612-4300 | 2014-04-10 |
| 1245671841 | David A Meyerson | Clinical Neuropsychologist | 2500 W Bradley Pl, Suite 100, Chicago, IL 60618-4702 | 2013-07-11 |
| 1700136850 | Melissa Shoemaker | Clinical Neuropsychologist | 2835 N Sheffield Ave Ste 202, Chicago, IL 60657-5083 | 2012-09-17 |
| 1518214451 | Christopher Conley Stewart | Clinical Neuropsychologist | 1645 W Jackson Blvd Ste 400, Chicago, IL 60612-3244 | 2012-08-09 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.