MEDICARE: MYCHOLE WILLIS SSP

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	103TS0200X	School Psychologist	2289879	IL

General Provider Information

NPI Number	:	1780190132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYCHOLE WILLIS SSP

Provider Business Mailing Address
First Line	:	41 E ELMWOOD DR
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-1104
Country	:	US
Telephone Number	:	708-647-7019
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 E ELMWOOD DR
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-1104
Country	:	US
Telephone Number	:	708-647-7019
Fax Number	:

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

Provider Enumeration Date	:	12/21/2017
Last Update Date	:	12/21/2017

Similar Medicare Providers

1396962106 — FLOSSMOOR SCHOOL DISTRICT 161
Practice Location Address:

41 E ELMWOOD DR
CHICAGO HEIGHTS, IL
60411-1104

Practice Phone: 708-647-7000
Practice Fax: 708-756-1565

1952817306 — MRS. AMBER GUMM
Practice Location Address:

41 E ELMWOOD DR
CHICAGO HEIGHTS, IL
60411-1104

Practice Phone: 708-647-7045
Practice Fax:

1003126137 — DR. MADHU VENKATA RAMA RAJU NADIMPALLI DDS
Practice Location Address:

5570 SILVER HILL RD
DISTRICT HEIGHTS, MD
20747-1104

Practice Phone: 301-202-2222
Practice Fax:

1215247135 — DR. SAPNA NANDYALA DDS
Practice Location Address:

5570 SILVER HILL RD
DISTRICT HEIGHTS, MD
20747-1104

Practice Phone: 302-202-2222
Practice Fax:

1841621042 — TAMARA TUCKER
Practice Location Address:

5303 NORTHFIELD RD , SUITE 115
BEDFORD HEIGHTS, OH
44146-1104

Practice Phone: 216-527-4740
Practice Fax:

1023421716 — MISS LOLITA MICHELLE SULLINS
Practice Location Address:

5303 NORTHFIELD RD , 814
BEDFORD HEIGHTS, OH
44146-1104

Practice Phone: 216-253-6268
Practice Fax:

Directions to “ MYCHOLE WILLIS SSP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.