Healthcare Provider Details

I. General information

NPI: 1053467258
Provider Name (Legal Business Name): STEVEN ALAN MEYERS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 W POLK ST SUITE 305
CHICAGO IL
60605-2000
US

IV. Provider business mailing address

47 W POLK ST SUITE 305
CHICAGO IL
60605-2000
US

V. Phone/Fax

Practice location:
  • Phone: 312-878-7005
  • Fax: 773-888-4401
Mailing address:
  • Phone: 312-878-7005
  • Fax: 773-888-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071005287
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071005287
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: