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General NPI Number Information
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NPI Number | 1003263112
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Entity Type | Individual
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Provider Name | RAE WATKINS PSYD
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Gender | Female
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 1519 W IRVING PARK RD STE 1
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City | CHICAGO
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State | IL
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Zip | 60613-2549
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Country | US
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Telephone | 773-600-7580
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 180051
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City | CHICAGO
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State | IL
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Zip | 60618-0025
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Country | US
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Telephone | 773-600-7580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071009266
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License Number State | IL
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