Healthcare Provider Details

I. General information

NPI: 1194240705
Provider Name (Legal Business Name): KATHARINE KHARAS PSYD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 EAST WASHINGTON STREET SUITE 908
CHICAGO IL
60602-1718
US

IV. Provider business mailing address

25 E WASHINGTON ST STE 908
CHICAGO IL
60602-1718
US

V. Phone/Fax

Practice location:
  • Phone: 773-330-5688
  • Fax:
Mailing address:
  • Phone: 773-330-5688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071.009179
License Number StateIL

VIII. Authorized Official

Name: DR. KATHARINE ELIZABETH KHARAS
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 773-330-5688