Provider Demographics
NPI:1316033392
Name:SEMMELHACK, DIANA J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:J
Last Name:SEMMELHACK
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 1:2118 NOYES ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2558
Mailing Address - Country:US
Mailing Address - Phone:847-491-0165
Mailing Address - Fax:847-492-9463
Practice Address - Street 1:2118 NOYES
Practice Address - Street 2:2118 NOYES
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-491-0165
Practice Address - Fax:630-515-7655
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200167Medicare PIN
IL209212Medicare PIN
ILP00378003Medicare PIN
IL213198Medicare PIN