MEDICARE: PATRICIA M MEADEN 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	071-005338	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001622652	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1285642553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA M MEADEN PH.D.

Provider Business Mailing Address
First Line	:	217 16TH ST
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-3226
Country	:	US
Telephone Number	:	847-256-0943
Fax Number	:	847-256-6363

Provider Business Practice Location Address
First Line	:	180 N MICHIGAN AVE
Second Line	:	SUITE 2403
City	:	CHICAGO
State	:	IL
Zip	:	60601-7401
Country	:	US
Telephone Number	:	312-920-0133
Fax Number	:

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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