Healthcare Provider Details

I. General information

NPI: 1841114741
Provider Name (Legal Business Name): KEVIN CHRISTOPHER WHITSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 CHARLEMAINE DR
AURORA IL
60504-6572
US

IV. Provider business mailing address

3617 CHARLEMAINE DR
AURORA IL
60504-6572
US

V. Phone/Fax

Practice location:
  • Phone: 630-747-7864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-005825
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: