Provider Demographics
NPI:1952473985
Name:KHOSHABA, DEANA LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEANA
Middle Name:LYNN
Last Name:KHOSHABA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1675 DEMPSTER ST
Mailing Address - Street 2:3RD FLR., YACKTMAN PAVILION, DEVELOPMENTAL PEDIATRICS
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1110
Mailing Address - Country:US
Mailing Address - Phone:847-318-9067
Mailing Address - Fax:847-723-9441
Practice Address - Street 1:1675 DEMPSTER ST
Practice Address - Street 2:3RD FLR., YACKTMAN PAVILION, DEVELOPMENTAL PEDIATRICS
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1110
Practice Address - Country:US
Practice Address - Phone:847-318-9067
Practice Address - Fax:847-723-9441
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical