MEDICARE: DR. ALAN P. CHILDS & ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1673724	OTHER	IL	BCBS PROVIDER #

General Provider Information

NPI Number	:	1205903697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ALAN P. CHILDS & ASSOCIATES

Provider Business Mailing Address
First Line	:	5920 N SAUGANASH LN
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-6044
Country	:	US
Telephone Number	:	773-685-4993
Fax Number	:	773-685-6744

Provider Business Practice Location Address
First Line	:	10415 S ROBERTS RD
Second Line	:
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-1931
Country	:	US
Telephone Number	:	708-430-5993
Fax Number	:	708-430-5476

Authorized Official
Title or Position	:	PRESIDENT AND CLINICAL DIRECTOR
Name	:	DR. ALAN P CHILDS
Credential	:	M.A., PSY.D.
Telephone Number	:	773-685-4993

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	08/22/2020

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