Provider Demographics
NPI:1194209106
Name:TUCKER, PHILIPPA (PSYD)
Entity type:Individual
Prefix:MS
First Name:PHILIPPA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:PIPPA
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-2040
Mailing Address - Fax:847-570-5315
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1700
Practice Address - Country:US
Practice Address - Phone:847-425-6400
Practice Address - Fax:847-425-6408
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071021038103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical