Active NPI
Paul John Heaton, PSY.D.
- Psychologist
- Northbrook, IL
National Provider Identifier
1508976499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 3000 Dundee Rd
Suite 411
Northbrook, IL 60062-2422 - Phone
- (224) 217-0800
- Fax
- (847) 729-6208
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | IL | Primary |
Addresses
Primary practice location
3000 Dundee Rd
Suite 411
Northbrook, IL 60062-2422
Mailing address
1828 Silverwillow Dr
Glenview, IL 60025-2025
Phone (224) 217-0800
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071-003498 | IL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508976499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1828 SILVERWILLOW DR",
"city": "GLENVIEW",
"state": "IL",
"postal_code": "600252025",
"telephone_number": "224-217-0800",
"fax_number": "847-729-6208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 DUNDEE RD",
"address_2": "SUITE 411",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600622422",
"telephone_number": "224-217-0800",
"fax_number": "847-729-6208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEATON",
"first_name": "PAUL",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.