Provider Demographics
NPI:1104833441
Name:HERMAN, CATHY ELLEN
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:ELLEN
Last Name:HERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5925
Mailing Address - Country:US
Mailing Address - Phone:312-357-0218
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE
Practice Address - Street 2:STE 605
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7425
Practice Address - Country:US
Practice Address - Phone:847-869-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004398103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071004398OtherLICENSE
IL071004398OtherLICENSE