Healthcare Provider Details

I. General information

NPI: 1861581365
Provider Name (Legal Business Name): CHERYL L MEJTA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 N SHEFFIELD AVE SUITE 500
CHICAGO IL
60657-5081
US

IV. Provider business mailing address

2835 N SHEFFIELD AVE SUITE 500
CHICAGO IL
60657-5081
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-2400
  • Fax: 773-296-1097
Mailing address:
  • Phone: 773-296-2400
  • Fax: 773-296-1097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number71002946
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: