Provider Demographics
NPI:1861481277
Name:DAVIS, NANCY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ANN
Last Name:DAVIS
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 1:8170 MCCORMICK BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2914
Mailing Address - Country:US
Mailing Address - Phone:847-410-2029
Mailing Address - Fax:847-410-2041
Practice Address - Street 1:8170 MCCORMICK BLVD STE 204
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2914
Practice Address - Country:US
Practice Address - Phone:847-410-2029
Practice Address - Fax:847-410-2041
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009464103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3982587Medicare ID - Type Unspecified