Kathy Dana Abbott, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071006594 Issued in IL

Practice address

3317 W 95TH St
Ste 205
Evergreen Park, IL 60805

Phone

(773) 807-0936

Fax

(773) 247-0507

NPI assigned

Oct 16, 2006

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 names 1

• Mrs. Kathy Dana Shannon Other name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kathy Abbott PSYD PC

  • Clinical Psychologist
  • Evergreen Park, IL
  • NPI 1326113838
  Medicare reassignment NPD Authorized official
• Davken Associates, P.C.

  • Clinical Psychologist
  • Deerfield, IL
  • NPI 1457393159
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516233600000",
    "number": "1922188929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4342 S TRUMBALL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60632",
            "telephone_number": "773-807-0936",
            "fax_number": "773-247-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3317 W 95TH ST",
            "address_2": "STE 205",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "60805",
            "telephone_number": "773-807-0936",
            "fax_number": "773-247-0507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABBOTT",
        "first_name": "KATHY",
        "middle_name": "DANA",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2018-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071006594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHY",
            "last_name": "SHANNON",
            "middle_name": "DANA",
            "prefix": "MRS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Deya Abdeljaber, PHARMD
• Yasmeen Naser Abdrabo
• Ambily Ann Abraham, PHARMD

• 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 Jan 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.