Provider Demographics
NPI:1437447141
Name:BUDISIN, IVAN (PHD)
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:
Last Name:BUDISIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31831
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-0831
Mailing Address - Country:US
Mailing Address - Phone:847-778-8371
Mailing Address - Fax:
Practice Address - Street 1:5001 N RAVENSWOOD AVE
Practice Address - Street 2:STE 228
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2711
Practice Address - Country:US
Practice Address - Phone:847-778-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008157103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling