Kristin R Davisson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071008238 Issued in IL

Practice address

1010 Lake St Ste 200
Oak Park, IL 60301-1132

Phone

(210) 201-2776

NPI assigned

Nov 30, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1063789485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 LAKE ST STE 20",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011147",
            "telephone_number": "210-201-2776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 LAKE ST STE 200",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011132",
            "telephone_number": "210-201-2776"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "53 W Jackson Blvd",
            "address_2": "Suite 635",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606043606",
            "country_code": "US",
            "telephone_number": "773-609-2053",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVISSON",
        "first_name": "KRISTIN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-30",
        "last_updated": "2022-03-23",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daryl Ellis Davis, DC
• Georgetta J Davis
• Julene Davis, PMHNP
• Sarah D Davis, EDM
• Stacey Davis, PMHNP-BC
• Dawn Bounds LTD
• Pablo De la Cruz, DPT
• Daisy De la Torre
• Victoria Adriana De la Torre
• Zhandra De Lira

• Clinical Psychologist in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.