Provider Demographics
NPI:1396823514
Name:ATKINSON, JOHN D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 RAVINIA PL
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3700
Mailing Address - Country:US
Mailing Address - Phone:708-349-4420
Mailing Address - Fax:708-349-4421
Practice Address - Street 1:700 RAVINIA PL
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3700
Practice Address - Country:US
Practice Address - Phone:708-349-4420
Practice Address - Fax:708-349-4421
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
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
IL0001636000OtherBLUECROSS/BLUESHIELD
ILP96754Medicare UPIN
IL0001636000OtherBLUECROSS/BLUESHIELD