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General NPI Number Information
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NPI Number | 1093153066
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Entity Type | Individual
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Provider Name | MEHGAN KATHLEEN DEVINE PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 1740 RIDGE AVE SUITE 200C, OFFICE B
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City | EVANSTON
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State | IL
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Zip | 60201-5918
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Country | US
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Telephone | 773-972-5885
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Fax |
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Provider Business Mailing Address
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Address Line | 2740 W FOSTER AVE LL7
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City | CHICAGO
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State | IL
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Zip | 60625
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Country | US
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Telephone | 773-878-8200
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Fax | 773-293-4197
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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 | 071008616
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License Number State | IL
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