Provider Demographics
NPI:1942533286
Name:MICHAELS, LINDA L (PSYD, MBA)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:L
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:PSYD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 N MICHIGAN AVE
Mailing Address - Street 2:STE 803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2826
Mailing Address - Country:US
Mailing Address - Phone:312-612-0444
Mailing Address - Fax:
Practice Address - Street 1:645 N MICHIGAN AVE
Practice Address - Street 2:STE 803
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2826
Practice Address - Country:US
Practice Address - Phone:312-612-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical