Provider Demographics
NPI:1659421212
Name:WYATT, JAMES KELLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KELLEY
Last Name:WYATT
Suffix:
Gender:M
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:1653 W CONGRESS PKWY
Mailing Address - Street 2:SLEEP DISORDERS CENTER, RUSH UNIVERSITY MEDICAL CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3833
Mailing Address - Country:US
Mailing Address - Phone:312-942-5440
Mailing Address - Fax:312-942-8961
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:SLEEP DISORDERS CENTER, RUSH UNIVERSITY MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-5440
Practice Address - Fax:312-942-8961
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2022-04-06
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Provider Licenses
StateLicense IDTaxonomies
IL071005918103TB0200X, 103T00000X, 103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth