Provider Demographics
NPI:1063079317
Name:PAULLIN, CATHLEEN MARTHA
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:MARTHA
Last Name:PAULLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 MILTON DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3310
Mailing Address - Country:US
Mailing Address - Phone:847-712-0580
Mailing Address - Fax:
Practice Address - Street 1:8502 BAILEY RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5333
Practice Address - Country:US
Practice Address - Phone:331-481-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2008925103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool