MEDICARE: DR. KATHLEEN S. BLEHART PSYD

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	071.009194	IL

General Provider Information

NPI Number	:	1679939706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN S. BLEHART PSYD

Provider Business Mailing Address
First Line	:	1212 N WELLS ST
Second Line	:	UNIT 903
City	:	CHICAGO
State	:	IL
Zip	:	60610-5693
Country	:	US
Telephone Number	:	312-593-4401
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 N WABASH AVE UNIT 1815
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-5661
Country	:	US
Telephone Number	:	312-593-4401
Fax Number	:

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

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	01/05/2016

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