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NPI Code Detail

MEDICARE: HARRY KENT PHD PC

MEDICARE: HARRY KENT PHD PC
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 PsychologistIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
104532067OTHERBCBS

General Provider Information

NPI Number : 1861475212
Entity Type Code : Organization
Provider Name (Legal Business Name) : HARRY KENT PHD PC
Provider Business Mailing Address
First Line : 3540 N SOUTHPORT
Second Line : #272
City : CHICAGO
State : IL
Zip : 60657
Country : US
Telephone Number : 773-398-2415
Fax Number :
Provider Business Practice Location Address
First Line : 77 N AIRLITE STREET
Second Line : PROVENA ST JOSEPH HOSPITAL
City : ELGIN
State : IL
Zip : 60123-4912
Country : US
Telephone Number : 847-695-3200
Fax Number : 947-622-3470
Authorized Official
Title or Position : PRESIDENT
Name : HARRY MASON KENT
Credential : PHD
Telephone Number : 773-398-2415
Provider Enumeration Date : 11/21/2005
Last Update Date : 08/22/2020

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