MEDICARE: DR. CASEY N. FOREMAN, LLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1275031536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. CASEY N. FOREMAN, LLC

Provider Business Mailing Address
First Line	:	50 BARNARD LN
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-5109
Country	:	US
Telephone Number	:	248-229-1720
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 LAKE COOK RD STE 502
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1454
Country	:	US
Telephone Number	:	248-229-1720
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	CASEY FOREMAN
Credential	:	PSY.D
Telephone Number	:	248-229-1720

Provider Enumeration Date	:	01/31/2018
Last Update Date	:	01/31/2018

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