Basic Information
| Provider Information | |||||||||
| NPI: | 1609339670 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COSTIN | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 485 W HAPPFIELD DR | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600047103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306151658 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3375 N ARLINGTON HEIGHTS RD STE K | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600047701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474384530 | ||||||||
| FaxNumber: | 8473944176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2019 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 071.010581 | IL | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103TC0700X | 071.010581 | IL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.