Individual
MICHAEL J INGERSOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
640 S WASHINGTON ST, NAPERVILLE, IL 60540-6603
(815) 942-6323
(815) 942-6363
Mailing address
PO BOX 713260, CHICAGO, IL 60677-0018
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071004707
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01618781
BC/BS
IL
01
—
680012120
MEDICARE RAILROAD
IL
Enumeration date
12/19/2005
Last updated
05/24/2023
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