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General NPI Number Information
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NPI Number | 1912547969
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Entity Type | Individual
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Provider Name | DR. EMILY O'HARA
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Gender | Female
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 3001 GREEN BAY RD
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-3048
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Country | US
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Telephone | 224-610-1499
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Fax |
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Provider Business Mailing Address
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Address Line | 6827 W HIGHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60631-2034
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Country | US
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Telephone | 773-706-3909
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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 | PSY-005201
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.010333
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License Number State | IL
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