Healthcare Provider Details

I. General information

NPI: 1861916710
Provider Name (Legal Business Name): KATHERINE MEJIA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10208 S INDIANAPOLIS AVE STE 301
CHICAGO IL
60617-6033
US

IV. Provider business mailing address

637 W 16TH ST APT 2E
CHICAGO IL
60616-1198
US

V. Phone/Fax

Practice location:
  • Phone: 866-413-1988
  • Fax: 866-628-8599
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071021011
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: