MEDICARE: DR. NANCY L. EASTON PSY.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	103TC0700X	Clinical Psychologist	071-006716	IL

General Provider Information

NPI Number	:	1538350665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY L. EASTON PSY.D.

Provider Business Mailing Address
First Line	:	3323 W CULLOM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1217
Country	:	US
Telephone Number	:	312-925-9477
Fax Number	:

Provider Business Practice Location Address
First Line	:	3323 W CULLOM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1217
Country	:	US
Telephone Number	:	312-925-9477
Fax Number	:

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

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	04/02/2021

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