Provider Demographics
NPI:1114019510
Name:PARKER, KATHLEEN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:PARKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N BERTEAU AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2928
Mailing Address - Country:US
Mailing Address - Phone:773-259-4239
Mailing Address - Fax:
Practice Address - Street 1:1340 REMINGTON RD
Practice Address - Street 2:STE T
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4821
Practice Address - Country:US
Practice Address - Phone:773-259-4239
Practice Address - Fax:630-924-5411
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201396Medicare ID - Type Unspecified