MEDICARE: DR. SHARON LYNN MCNEELY 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	103T00000X	Psychologist
2	103TC0700X	Clinical Psychologist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1673299	OTHER	IL	BLUE CROSS PROVIDER NUMBE

General Provider Information

NPI Number	:	1366418857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARON LYNN MCNEELY PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 34421
Second Line	:	6315 W. ADDISON STREET
City	:	CHICAGO
State	:	IL
Zip	:	60634-0421
Country	:	US
Telephone Number	:	773-736-2340
Fax Number	:	773-736-7033

Provider Business Practice Location Address
First Line	:	6315 W ADDISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4002
Country	:	US
Telephone Number	:	773-736-2340
Fax Number	:	773-736-7033

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	09/11/2025

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