Provider Demographics
NPI:1245362789
Name:STILLMAN, KATHLEEN Q (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:Q
Last Name:STILLMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1015
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7506
Mailing Address - Country:US
Mailing Address - Phone:312-938-8704
Mailing Address - Fax:312-266-2276
Practice Address - Street 1:151 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1015
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7506
Practice Address - Country:US
Practice Address - Phone:312-938-8704
Practice Address - Fax:312-266-2276
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X, 103TF0000X, 103TH0100X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1673188OtherBCBSI ID NUMBER
IL956320Medicare ID - Type UnspecifiedMEDICARE ID NUMBER