Provider Demographics
NPI:1497119507
Name:KERN, DANIEL M (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:KERN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 N MICHIGAN AVE STE 803
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5123
Mailing Address - Country:US
Mailing Address - Phone:630-415-8781
Mailing Address - Fax:
Practice Address - Street 1:645 N MICHIGAN AVE STE 803
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5123
Practice Address - Country:US
Practice Address - Phone:630-415-8781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010531103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty