MEDICARE: DR. ROBERT L. DAVENPORT PH.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	71-2052	IL

General Provider Information

NPI Number	:	1902855356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT L. DAVENPORT PH.D.

Provider Business Mailing Address
First Line	:	1535 LAKE COOK RD
Second Line	:	SUITE # 111
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1447
Country	:	US
Telephone Number	:	847-498-4744
Fax Number	:	847-498-4811

Provider Business Practice Location Address
First Line	:	1535 LAKE COOK RD
Second Line	:	SUITE # 111
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1450
Country	:	US
Telephone Number	:	847-498-4744
Fax Number	:	847-498-4811

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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