Provider Demographics
NPI:1467660050
Name:MAGRANE, MINDY SUE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:SUE
Last Name:MAGRANE
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 1:5508 N GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1217
Mailing Address - Country:US
Mailing Address - Phone:773-383-2593
Mailing Address - Fax:
Practice Address - Street 1:8601 W BRYN MAWR AVE
Practice Address - Street 2:BLDG B1, SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3570
Practice Address - Country:US
Practice Address - Phone:773-695-0900
Practice Address - Fax:773-695-0700
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71007281103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical