Provider Demographics
NPI:1346300050
Name:PASIC, KATICA (PSY D)
Entity type:Individual
Prefix:
First Name:KATICA
Middle Name:
Last Name:PASIC
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7714 N EASTLAKE TER
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1304
Mailing Address - Country:US
Mailing Address - Phone:773-761-0026
Mailing Address - Fax:312-612-1479
Practice Address - Street 1:7714 N EASTLAKE TER
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1304
Practice Address - Country:US
Practice Address - Phone:773-761-0026
Practice Address - Fax:312-612-1479
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004872103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071004872Medicaid
IL071-004872OtherSTATE LICENSE NUMBER