Vida Bernadette Dyson, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Practice address

9730 S Western Ave
Suite 627
Evergreen Park, IL 60805-2814

Phone

(708) 261-8922

Fax

(773) 881-9535

NPI assigned

Apr 9, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881717288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9747 S OAKLEY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606431720",
            "telephone_number": "773-429-1847",
            "fax_number": "773-881-9535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9730 S WESTERN AVE",
            "address_2": "SUITE 627",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052814",
            "telephone_number": "708-261-8922",
            "fax_number": "773-881-9535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYSON",
        "first_name": "VIDA",
        "middle_name": "BERNADETTE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0001635116",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stefan Dubas, DDS
• Alec Ducham, LPC
• Aileen Marie Dukelow, R.D.
• Maggie Duque, MA
• Karianne Deborah Dvorak
• Carly Scot Eakin, PA-C
• Kristin Egan
• Joe Eggebeen, M.D.
• Krystle Ekhoff, RN, IBCLC
• Ellen M Hennecke Dosc

• Clinical Psychologist in Evergreen Park, IL
• Providers in Evergreen 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 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.

Verify at the official NPI Registry.