Provider Demographics
NPI:1700857745
Name:POWERS, LINDA LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LEE
Last Name:POWERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1431
Mailing Address - Country:US
Mailing Address - Phone:847-864-4196
Mailing Address - Fax:847-864-4196
Practice Address - Street 1:1480 N NORTHWEST HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1431
Practice Address - Country:US
Practice Address - Phone:847-864-4196
Practice Address - Fax:847-864-4196
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-29
Last Update Date:2007-07-08
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
IL340540Medicare ID - Type Unspecified