Keenan Ferrell, PSY.D.
Individual provider Active NPI Clinical Psychologist · Chicago, IL
NPI 1801927702 · NPPES record last updated Jul 8, 2007
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Feb 19, 2015.
Key facts
- NPI
- 1801927702
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- Practice address
- 5455 N Sheridan Rd
1709
Chicago, IL 60640-1958 - Phone
- (773) 944-5301
- Fax
- (773) 944-5302
- NPI assigned
- Mar 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.006168 | IL | MD | Clinical Psychologist |
| 20041967A | IN | MD | Clinical Psychologist |
| 34123 | TX | MD | General Practice Dentistry |
| 00987 | IA | MD | Pediatric Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Davken Associates, P.C. | Clinical | Past | Accepting new patients |
| Autumn Healthcare of Illinois | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 00987 | IA | |
| Clinical Psychologist | 103TC0700X | 20041967A | IN | |
| Clinical Psychologist | 103TC0700X | IL | Yes |
Addresses
Primary practice location
5455 N Sheridan Rd
1709
Chicago, IL 60640-1958
Mailing address
5455 N Sheridan Rd
1709
Chicago, IL 60640-1958
Phone (773) 944-5301
Other providers in Chicago, IL
- Imelda Gloria Ferreira
- Maria Rosario Ferreira
- Ashley Ferrell
- James D Ferrell
- Jessica Ferrell
- Maruwa Ferrell
- Robyn Ferrell
- Daniela Alejandra Ferrer Gonzalez
- Alicia Ferrer
- Christian L Ferrer
All providers in Chicago, IL · Clinical Psychologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- OIG LEIE (HHS Office of Inspector General).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.