Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071.010266 | IL |
Y | 103TC0700X | Clinical Psychologist | 071.010266 | IL |
N | 103TH0100X | Health Service | 20043306B | IN |
NPI | 1023486040 |
---|---|
Provider Name | Melissa Meinen |
First Address | Chicago, IL 60608-6410 |
Second Address | Chicago, IL 60614-1850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2015 |
Last Update Date | 01/06/2020 |