Provider Demographics
NPI:1639306988
Name:WHITE, MICHELLE SARAH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:SARAH
Last Name:WHITE
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 1:4801 W PETERSON AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5713
Mailing Address - Country:US
Mailing Address - Phone:773-315-1715
Mailing Address - Fax:
Practice Address - Street 1:4801 W PETERSON AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5713
Practice Address - Country:US
Practice Address - Phone:773-282-2322
Practice Address - Fax:773-282-2853
Is Sole Proprietor?:No
Enumeration Date:2009-06-14
Last Update Date:2009-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007672103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical