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General NPI Number Information
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NPI Number | 1376929315
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Entity Type | Individual
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Provider Name | MICHELLE KALNASY POWELL PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 07/31/2015
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 53 W JACKSON BLVD STE 662
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City | CHICAGO
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State | IL
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Zip | 60604-3452
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Country | US
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Telephone | 240-298-4110
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Fax |
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Provider Business Mailing Address
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Address Line | 425 S OAK PARK AVE APT B
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City | OAK PARK
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State | IL
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Zip | 60302-4907
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Country | US
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Telephone | 240-298-4110
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071009486
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License Number State | IL
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