Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | IL | |
N | 103T00000X | Psychologist | IL | |
N | 103G00000X | Clinical Psychologist | IL | |
N | 103TC0700X | Clinical Psychologist | IL | |
N | 103TF0000X | Family Psychologist | IL | |
N | 103TH0100X | Health Service | IL |
NPI | 1245362789 |
---|---|
Provider Name | Dr. Kathleen Q. Stillman |
First Address | Chicago, IL 60601-7506 |
Second Address | Chicago, IL 60601-7506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1673188 | BCBSI ID NUMBER (01) | IL |