Provider Demographics
NPI:1821432246
Name:KATHLEEN O'GRADY PHD PC
Entity Type:Organization
Organization Name:KATHLEEN O'GRADY PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-888-1104
Mailing Address - Street 1:1555 NAPERVILLE WHEATON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1557
Mailing Address - Country:US
Mailing Address - Phone:312-888-1104
Mailing Address - Fax:
Practice Address - Street 1:1555 NAPERVILLE WHEATON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1557
Practice Address - Country:US
Practice Address - Phone:312-888-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-003766103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty