Provider Demographics
NPI:1487665311
Name:TERRY, SEAN CASS (PSYD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:CASS
Last Name:TERRY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 CHATEAU KNLS
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3413
Mailing Address - Country:US
Mailing Address - Phone:563-459-9725
Mailing Address - Fax:
Practice Address - Street 1:800 E NORTHWEST HWY STE 106B
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3457
Practice Address - Country:US
Practice Address - Phone:847-867-7924
Practice Address - Fax:847-299-4952
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001160103T00000X, 103TC0700X
IL071007347103TA0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216111Medicare PIN