Provider Demographics
NPI:1114221082
Name:KONNO, AYAKO (PSYD)
Entity type:Individual
Prefix:DR
First Name:AYAKO
Middle Name:
Last Name:KONNO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 S MICHIGAN AVE
Mailing Address - Street 2:#1615
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2521
Mailing Address - Country:US
Mailing Address - Phone:312-545-8480
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE
Practice Address - Street 2:SUITE 760
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7511
Practice Address - Country:US
Practice Address - Phone:312-545-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007697103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical