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General NPI Number Information
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NPI Number | 1760028377
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Entity Type | Individual
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Provider Name | KATYA VISWANADHAN PSY.D
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Gender | Female
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 1854 SHERMAN AVE
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City | EVANSTON
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State | IL
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Zip | 60201-3795
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Country | US
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Telephone | 847-565-6400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5213
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City | EVANSTON
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State | IL
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Zip | 60204-5213
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Country | US
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Telephone | 847-565-6400
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 024755
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License Number State | NY
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