Provider Demographics
NPI:1659460715
Name:MESTEMAKER, TONYA MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:MARIE
Last Name:MESTEMAKER
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 1:4443 N ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4501
Mailing Address - Country:US
Mailing Address - Phone:773-383-7700
Mailing Address - Fax:
Practice Address - Street 1:900 N SHORE DR
Practice Address - Street 2:SUITE 174
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2243
Practice Address - Country:US
Practice Address - Phone:773-383-7700
Practice Address - Fax:847-615-1697
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
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
IL04932470OtherBCBS PROVIDER NUMBER