MEDICARE: DR. DANIEL K. PHILLIP 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	071009817	IL

General Provider Information

NPI Number	:	1508257684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL K. PHILLIP PSY.D.

Provider Business Mailing Address
First Line	:	2223 WASHINGTON ST UNIT 102
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-1557
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2223 WASHINGTON ST UNIT 102
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-1557
Country	:	US
Telephone Number	:	312-324-4419
Fax Number	:

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

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	04/21/2025

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