MEDICARE: DR. MELANIE LOUISE TERBOVIC PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071-006258	IL

General Provider Information

NPI Number	:	1194703041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELANIE LOUISE TERBOVIC PH.D.

Provider Business Mailing Address
First Line	:	1 GOLFVIEW RD
Second Line	:	SUITE 4
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-1210
Country	:	US
Telephone Number	:	847-726-2400
Fax Number	:	847-726-2409

Provider Business Practice Location Address
First Line	:	1 GOLFVIEW RD
Second Line	:	SUITE 4
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-1210
Country	:	US
Telephone Number	:	847-726-1400
Fax Number	:	847-726-2409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2006
Last Update Date	:	03/18/2009

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