MEDICARE: DR. KERRY BROWN HASBROOK PH.D.

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	103TC2200X	Clinical Child & Adolescent Psychologist	071.006324	IL

General Provider Information

NPI Number	:	1528136157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY BROWN HASBROOK PH.D.

Provider Business Mailing Address
First Line	:	2601 COMPASS RD
Second Line	:	SUITE 120
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8077
Country	:	US
Telephone Number	:	847-920-5546
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 COMPASS RD
Second Line	:	SUITE 120
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8077
Country	:	US
Telephone Number	:	847-920-5546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/02/2012

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