MEDICARE: KATICA PASIC PSY. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071-004872	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	071-004872	OTHER	IL	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1346300050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATICA PASIC PSY. D.

Provider Business Mailing Address
First Line	:	7714 N EASTLAKE TER
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60626-1304
Country	:	US
Telephone Number	:	773-761-0026
Fax Number	:	312-612-1479

Provider Business Practice Location Address
First Line	:	7714 N EASTLAKE TER
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60626-1304
Country	:	US
Telephone Number	:	773-761-0026
Fax Number	:	312-612-1479

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	09/27/2022

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