Active NPI
Kathleen V Shea, PHD
- Clinical Psychologist
- Antioch, IL
National Provider Identifier
1235220369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071003133
- Practice address
- 42258 N Crawford Rd
A-1
Antioch, IL 60002-9570 - Phone
- (847) 217-7660
- Fax
- (847) 395-9973
- NPI assigned
- Sep 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071003133 | IL | Primary |
Addresses
Primary practice location
42258 N Crawford Rd
A-1
Antioch, IL 60002-9570
Mailing address
42258 N Crawford Rd
A-1
Antioch, IL 60002-9570
Phone (847) 217-7660
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0497205371 | Other | IL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071003133 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342569600000",
"number": "1235220369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42258 N CRAWFORD RD",
"address_2": "A-1",
"city": "ANTIOCH",
"state": "IL",
"postal_code": "600029570",
"telephone_number": "847-217-7660",
"fax_number": "847-395-9973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42258 N CRAWFORD RD",
"address_2": "A-1",
"city": "ANTIOCH",
"state": "IL",
"postal_code": "600029570",
"telephone_number": "847-217-7660",
"fax_number": "847-395-9973"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEA",
"first_name": "KATHLEEN",
"middle_name": "V",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-27",
"last_updated": "2012-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071003133",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0497205371",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Antioch, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.