Provider Demographics
NPI:1417139106
Name:KHAN, YASMEEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YASMEEN
Middle Name:
Last Name:KHAN
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 1:1751 S NAPERVILLE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189
Mailing Address - Country:US
Mailing Address - Phone:630-674-1138
Mailing Address - Fax:630-690-3353
Practice Address - Street 1:1751 S NAPERVILLE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189
Practice Address - Country:US
Practice Address - Phone:630-674-1138
Practice Address - Fax:630-690-3353
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071 005466103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623115OtherBLUE CROSS BLUE SHIELD