| Kelly Behrends, Psyd, Pc | |
|
1248 American Way Suite B Libertyville IL 60048-3936 | |
| (224) 433-6744 | |
| (224) 433-6998 |
| Full Name | Kelly Behrends, Psyd, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 1248 American Way, Libertyville, Illinois |
| Authorized Official Name and Position | Kelly Jennette Behrends (PRESIDENT) |
| Authorized Official Contact | 8477545570 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly Behrends, Psyd, Pc 1248 American Way Suite B Libertyville IL 60048-3936 Ph: (224) 433-6744 | Kelly Behrends, Psyd, Pc 1248 American Way Suite B Libertyville IL 60048-3936 Ph: (224) 433-6744 |
| NPI Number | 1962632463 |
|---|---|
| Provider Enumeration Date | 07/17/2009 |
| Last Update Date | 09/06/2013 |
| Medicare PECOS PAC ID | 5991858516 |
|---|---|
| Medicare Enrollment ID | O20090729000897 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962632463 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071.007337 (Illinois) | Primary |
| Provider Name | Kelly J Behrends |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598809113 PECOS PAC ID: 1456404078 Enrollment ID: I20090729000888 |
| Provider Name | Jill C Sanderson-davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063664787 PECOS PAC ID: 5193861607 Enrollment ID: I20091013000686 |
| Provider Name | Heather Brown |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558596387 PECOS PAC ID: 5496939530 Enrollment ID: I20110413000962 |
| Provider Name | Daniella L Wiegand |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033295902 PECOS PAC ID: 1759693856 Enrollment ID: I20150702000136 |
| Provider Name | Kaitlin B Lavris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538534540 PECOS PAC ID: 1254609167 Enrollment ID: I20170619001231 |
| Provider Name | Mindy E Forman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851768725 PECOS PAC ID: 5890034763 Enrollment ID: I20190312001003 |
| Provider Name | Mark A Zissman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033607031 PECOS PAC ID: 7517353808 Enrollment ID: I20220427001169 |
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