Provider Demographics
NPI:1285022251
Name:ANDERSON, TEVYN P (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TEVYN
Middle Name:P
Last Name:ANDERSON
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 1:5042 N GLENWOOD AVE
Mailing Address - Street 2:APT. 2W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2870
Mailing Address - Country:US
Mailing Address - Phone:847-769-1873
Mailing Address - Fax:
Practice Address - Street 1:5042 N GLENWOOD AVE
Practice Address - Street 2:APT. 2W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2870
Practice Address - Country:US
Practice Address - Phone:847-769-1873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical