Provider Demographics
NPI:1851446645
Name:PHILBEN, KATHLEEN (PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PHILBEN
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 1:1804 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4037
Mailing Address - Country:US
Mailing Address - Phone:847-332-2279
Mailing Address - Fax:
Practice Address - Street 1:1024 LAKE AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1764
Practice Address - Country:US
Practice Address - Phone:847-251-1872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-12-14
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
IL1622884OtherBLUE CROSS BLUE SHEILD
IL4244296OtherAETNA
IL1622884OtherBLUE CROSS BLUE SHEILD
ILR22043Medicare UPIN