Provider Demographics
NPI:1306109244
Name:AINSWORTH, COURTENAY ROURKE (PHD)
Entity type:Individual
Prefix:DR
First Name:COURTENAY
Middle Name:ROURKE
Last Name:AINSWORTH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4726 N WINCHESTER AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4372
Mailing Address - Country:US
Mailing Address - Phone:708-609-7475
Mailing Address - Fax:
Practice Address - Street 1:4726 N WINCHESTER AVE
Practice Address - Street 2:UNIT B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4372
Practice Address - Country:US
Practice Address - Phone:708-609-7475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008330103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist