MEDICARE: DR. STEVEN ALLEN KVAAL PHD

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		IL

General Provider Information

NPI Number	:	1609946300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN ALLEN KVAAL PHD

Provider Business Mailing Address
First Line	:	430 S MICHIGAN AVE
Second Line	:	ROOSEVELT UNIVERSITY
City	:	CHICAGO
State	:	IL
Zip	:	60605-1313
Country	:	US
Telephone Number	:	312-341-6374
Fax Number	:	312-341-6362

Provider Business Practice Location Address
First Line	:	2751 W WINONA ST
Second Line	:	SWEDISH COVENANT HOSPITAL
City	:	CHICAGO
State	:	IL
Zip	:	60625-2508
Country	:	US
Telephone Number	:	773-878-8200
Fax Number	:	773-907-3032

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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