Provider Demographics
NPI:1114064334
Name:THEUS, FREDERIKA COLLEEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIKA
Middle Name:COLLEEN
Last Name:THEUS
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 1:130 N HUMPHREY AVE
Mailing Address - Street 2:#2N
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2548
Mailing Address - Country:US
Mailing Address - Phone:773-412-1491
Mailing Address - Fax:
Practice Address - Street 1:825 N CASS AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1132
Practice Address - Country:US
Practice Address - Phone:773-412-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005533103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical