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General NPI Number Information
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NPI Number | 1700136850
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Entity Type | Individual
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Provider Name | MELISSA SHOEMAKER PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 2835 N SHEFFIELD AVE STE 202
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City | CHICAGO
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State | IL
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Zip | 60657-5083
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Country | US
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Telephone | 739-384-6007
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Fax | 773-938-4600
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Provider Business Mailing Address
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Address Line | 2726 N LAKEWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60614-3629
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Country | US
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Telephone | 773-746-7001
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Fax | 773-938-4700
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071008951
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License Number State | IL
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