Provider Demographics
NPI:1235154477
Name:OMAN, WENDY (PSYD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:OMAN
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 1:450 W 37TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-1712
Mailing Address - Country:US
Mailing Address - Phone:773-550-6344
Mailing Address - Fax:
Practice Address - Street 1:3303 S HALSTED ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6705
Practice Address - Country:US
Practice Address - Phone:773-550-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634699OtherBLUE CROSS/SHIELD #
IL01634699OtherBLUE CROSS/SHIELD #