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NPI Code Detail

MEDICARE: DR. ERIN KRISTINA BASALAY PSY.D.

MEDICARE: DR. ERIN KRISTINA BASALAY 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
1103TC0700XClinical Psychologist071008280IL

General Provider Information

NPI Number : 1588937767
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIN KRISTINA BASALAY PSY.D.
Provider Business Mailing Address
First Line : 1723 S 5TH PL
Second Line :
City : ST CHARLES
State : IL
Zip : 60174-4324
Country : US
Telephone Number : 847-529-6421
Fax Number :
Provider Business Practice Location Address
First Line : 5730 W ROOSEVELT RD
Second Line :
City : CHICAGO
State : IL
Zip : 60644-1580
Country : US
Telephone Number : 773-921-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2012
Last Update Date : 02/17/2012

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