Provider Demographics
NPI:1023486040
Name:MEINEN, MELISSA (PSYD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MEINEN
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 1:3211 S RACINE AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6410
Mailing Address - Country:US
Mailing Address - Phone:763-732-9681
Mailing Address - Fax:
Practice Address - Street 1:2502 N CLARK ST STE 206
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1850
Practice Address - Country:US
Practice Address - Phone:773-850-0294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010266103TC0700X
IN20043306B103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service