Provider Demographics
NPI:1003325887
Name:WOMONTREE, MICHELE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:WOMONTREE
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 1:11191 ILLINOIS RT 185
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049
Mailing Address - Country:US
Mailing Address - Phone:217-502-6039
Mailing Address - Fax:217-532-2089
Practice Address - Street 1:11191 ILLINOIS RT 185
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:IL
Practice Address - Zip Code:62049
Practice Address - Country:US
Practice Address - Phone:217-532-2001
Practice Address - Fax:217-532-2089
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical