MEDICARE: DR. SEAN CASS TERRY 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	103T00000X	Psychologist	001160	IA
2	103TA0700X	Adult Development & Aging Psychologist	071007347	IL
3	103TC0700X	Clinical Psychologist	001160	IA
4	103TC0700X	Clinical Psychologist	071007347	IL

General Provider Information

NPI Number	:	1487665311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN CASS TERRY PSY.D.

Provider Business Mailing Address
First Line	:	1216 CHATEAU KNLS
Second Line	:
City	:	BETTENDORF
State	:	IA
Zip	:	52722-3413
Country	:	US
Telephone Number	:	563-459-9725
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E NORTHWEST HWY STE 106B
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-3457
Country	:	US
Telephone Number	:	847-867-7924
Fax Number	:	847-299-4952

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	12/12/2018

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