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General NPI Number Information
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NPI Number | 1821432246
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Entity Type | Organization
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Legal Business Name | KATHLEEN O'GRADY PHD PC
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 1555 NAPERVILLE WHEATON RD SUITE 103
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City | NAPERVILLE
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State | IL
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Zip | 60563-1557
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Country | US
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Telephone | 312-888-1104
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Fax |
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Provider Business Mailing Address
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Address Line | 1555 NAPERVILLE WHEATON RD SUITE 103
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City | NAPERVILLE
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State | IL
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Zip | 60563-1557
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Country | US
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Telephone | 312-888-1104
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHLEEN O'GRADY
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Credential | PHD
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Telephone | 312-888-1104
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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 | 071-003766
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License Number State | IL
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