Healthcare Provider Details

I. General information

NPI: 1891026340
Provider Name (Legal Business Name): CHICAGO PSYCHOLOGIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 W NORTHWEST HWY
PALATINE IL
60067-2414
US

IV. Provider business mailing address

6348 N MILWAUKEE AVE #143
CHICAGO IL
60646-3728
US

V. Phone/Fax

Practice location:
  • Phone: 773-771-6604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number071007182
License Number StateIL

VIII. Authorized Official

Name: DR. KARLA V ANDERSON
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 773-771-6604