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General NPI Number Information
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NPI Number | 1154149961
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Entity Type | Individual
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Provider Name | JASMINE ALKHATIB PSYD
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Gender | Female
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 4164 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60618-3083
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Country | US
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Telephone | 312-870-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 4852 N CENTRAL PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60625-5604
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Country | US
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Telephone | 708-288-4136
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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 | 071.011305
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License Number State | IL
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