Healthcare Provider Details

I. General information

NPI: 1356405633
Provider Name (Legal Business Name): CANDACE KAY MCMILLAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11952 S HARLEM AVE
PALOS HEIGHTS IL
60463-1167
US

IV. Provider business mailing address

88 OLD CREEK RD
PALOS PARK IL
60464-1409
US

V. Phone/Fax

Practice location:
  • Phone: 773-519-4103
  • Fax: 708-361-5222
Mailing address:
  • Phone: 708-448-4115
  • Fax: 708-448-4115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1629342
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: