| Icon Psychologies Corp | |
|
620 N River Rd Ste 106 Naperville IL 60563-8951 | |
| (630) 364-2484 | |
| (630) 536-8511 |
| Full Name | Icon Psychologies Corp |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 620 N River Rd Ste 106, Naperville, Illinois |
| Authorized Official Name and Position | Soberekon M Koko (OWNER/MEDICAL DIRECTOR) |
| Authorized Official Contact | 3123426066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Icon Psychologies Corp 620 N River Rd Ste 106 Naperville IL 60563-8951 Ph: (630) 364-2484 | Icon Psychologies Corp 620 N River Rd Ste 106 Naperville IL 60563-8951 Ph: (630) 364-2484 |
| NPI Number | 1972990497 |
|---|---|
| Provider Enumeration Date | 04/22/2015 |
| Last Update Date | 11/26/2017 |
| Medicare PECOS PAC ID | 4880914423 |
|---|---|
| Medicare Enrollment ID | O20150521000622 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972990497 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Soberekon M Koko |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992918866 PECOS PAC ID: 2860590528 Enrollment ID: I20070605000202 |
| Provider Name | Taryrsha Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821552761 PECOS PAC ID: 7911246368 Enrollment ID: I20190228002263 |
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