Healthcare Provider Details

I. General information

NPI: 1669674792
Provider Name (Legal Business Name): TREVA B ANDERSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 EXECUTIVE PL SUITE 404
GENEVA IL
60134-3807
US

IV. Provider business mailing address

1250 EXECUTIVE PL SUITE 404
GENEVA IL
60134-3807
US

V. Phone/Fax

Practice location:
  • Phone: 630-232-7245
  • Fax: 630-232-7246
Mailing address:
  • Phone: 630-232-7245
  • Fax: 630-232-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: