Healthcare Provider Details

I. General information

NPI: 1396895454
Provider Name (Legal Business Name): TIMOTHY DONALD MCMANUS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INGALLS HOSPITAL ACUTE REHABILITATION UNIT ONE INGALLS DR.
HARVEY IL
60426-9988
US

IV. Provider business mailing address

8210 HILLCREST DR
ORLAND PARK IL
60462-1845
US

V. Phone/Fax

Practice location:
  • Phone: 708-915-4237
  • Fax: 708-915-4023
Mailing address:
  • Phone: 708-917-0088
  • Fax: 708-915-4023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: