MEDICARE: SHEA MICHELLE LEMLEY BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1053688077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEA MICHELLE LEMLEY BCBA

Provider Business Mailing Address
First Line	:	1036 N DEARBORN ST
Second Line	:	#202
City	:	CHICAGO
State	:	IL
Zip	:	60610-3127
Country	:	US
Telephone Number	:	312-772-4816
Fax Number	:	773-409-5667

Provider Business Practice Location Address
First Line	:	1036 N DEARBORN ST
Second Line	:	#202
City	:	CHICAGO
State	:	IL
Zip	:	60610-3127
Country	:	US
Telephone Number	:	312-772-4816
Fax Number	:	773-409-5667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	11/18/2011

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