Provider Demographics
NPI:1003259227
Name:FRANK, MICHELLE T (PSYD)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:T
Last Name:FRANK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14953 S VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-5804
Mailing Address - Country:US
Mailing Address - Phone:815-609-1544
Mailing Address - Fax:815-609-1670
Practice Address - Street 1:1448 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-9225
Practice Address - Country:US
Practice Address - Phone:773-486-4617
Practice Address - Fax:773-486-4936
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008579103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical