Healthcare Provider Details

I. General information

NPI: 1881265528
Provider Name (Legal Business Name): HEATHER MCDERMOTT PSYD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2021
Last Update Date: 07/04/2021
Certification Date: 07/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 KENT RD
KENILWORTH IL
60043-1031
US

IV. Provider business mailing address

PO BOX 83
KENILWORTH IL
60043-0083
US

V. Phone/Fax

Practice location:
  • Phone: 808-285-4776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HEATHER MCDERMOTT
Title or Position: MANAGING MEMBER
Credential:
Phone: 808-285-4776