Healthcare Provider Details

I. General information

NPI: 1891894812
Provider Name (Legal Business Name): KATHLEEN A KAPP-SIMON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 N. OAK PARK AVE SHRINERS HOSPITALS FOR CHILDREN CHICAGO
CHICAGO IL
60707
US

IV. Provider business mailing address

SHRINERS HOSPITAL FOR CHILDREN CHICAGO P. O. BOX 8500, LOCKBOX 7642
PHILADELPHIA PA
19178-7642
US

V. Phone/Fax

Practice location:
  • Phone: 773-385-5407
  • Fax: 773-385-5830
Mailing address:
  • Phone: 813-281-8115
  • Fax: 813-281-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071 002924
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: