Provider Demographics
NPI:1932304102
Name:MAHON, MELISSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:MAHON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:JUERGENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:863 RAVINIA CT
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-3213
Mailing Address - Country:US
Mailing Address - Phone:847-287-0916
Mailing Address - Fax:
Practice Address - Street 1:28 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2111
Practice Address - Country:US
Practice Address - Phone:847-287-0916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-008253103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04515143OtherBCBS#