Provider Demographics
NPI:1265710180
Name:CASSIDAY, KAREN LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LYNN
Last Name:CASSIDAY
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 1:1500 SKOKIE BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4121
Mailing Address - Country:US
Mailing Address - Phone:847-559-0001
Mailing Address - Fax:
Practice Address - Street 1:1500 SKOKIE BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4121
Practice Address - Country:US
Practice Address - Phone:847-559-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004439103TC0700X
WI1622103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical