Healthcare Provider Details

I. General information

NPI: 1285642553
Provider Name (Legal Business Name): PATRICIA M MEADEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N MICHIGAN AVE SUITE 2403
CHICAGO IL
60601-7401
US

IV. Provider business mailing address

217 16TH ST
WILMETTE IL
60091-3226
US

V. Phone/Fax

Practice location:
  • Phone: 312-920-0133
  • Fax:
Mailing address:
  • Phone: 847-256-0943
  • Fax: 847-256-6363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-005338
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: