| Dr Kenneth T Washington Llc | |
|
18237 Kedzie Ave Homewood IL 60430-1411 | |
| (708) 433-9779 | |
| Not Available |
| Full Name | Dr Kenneth T Washington Llc |
|---|---|
| Speciality | Psychologist |
| Location | 18237 Kedzie Ave, Homewood, Illinois |
| Authorized Official Name and Position | Kenneth T Washington (DIRECTOR) |
| Authorized Official Contact | 7084339779 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Kenneth T Washington Llc 18237 Kedzie Ave Homewood IL 60430-1411 Ph: (708) 433-9779 | Dr Kenneth T Washington Llc 18237 Kedzie Ave Homewood IL 60430-1411 Ph: (708) 433-9779 |
| NPI Number | 1649861014 |
|---|---|
| Provider Enumeration Date | 01/28/2021 |
| Last Update Date | 11/13/2023 |
| Certification Date | 11/13/2023 |
| Medicare PECOS PAC ID | 0446609580 |
|---|---|
| Medicare Enrollment ID | O20231214000343 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649861014 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Kenneth Terrell Washington |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295326668 PECOS PAC ID: 1355790494 Enrollment ID: I20231214000390 |
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