Healthcare Provider Details

I. General information

NPI: 1730423765
Provider Name (Legal Business Name): HEATHER M PRAYOR-PATTERSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 PFINGSTEN RD
GLENVIEW IL
60026-1339
US

IV. Provider business mailing address

2180 PFINGSTEN RD
GLENVIEW IL
60026-1339
US

V. Phone/Fax

Practice location:
  • Phone: 847-503-4500
  • Fax: 847-657-5754
Mailing address:
  • Phone: 847-503-4500
  • Fax: 847-657-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008528
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: