Provider Demographics
NPI:1326069683
Name:KASDAN, LISA N (PSYD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:N
Last Name:KASDAN
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 1:4201 LAKE COOK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1060
Mailing Address - Country:US
Mailing Address - Phone:847-767-7400
Mailing Address - Fax:
Practice Address - Street 1:4201 LAKE COOK RD STE 100
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1060
Practice Address - Country:US
Practice Address - Phone:847-767-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005943103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical