Provider Demographics
NPI:1043592892
Name:ROSSMAN, H KINTON (PHD)
Entity type:Individual
Prefix:
First Name:H
Middle Name:KINTON
Last Name:ROSSMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:KINTON
Other - Last Name:ROSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1634 W COLUMBIA AVE APT 1N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4166
Mailing Address - Country:US
Mailing Address - Phone:270-348-6313
Mailing Address - Fax:
Practice Address - Street 1:1634 W COLUMBIA AVE APT 1N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-4166
Practice Address - Country:US
Practice Address - Phone:270-348-6313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010043103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL403416313001Medicaid