MEDICARE: CHICAGO PSYCHOLOGICAL WELLNESS CENTER, PLLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1942875901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO PSYCHOLOGICAL WELLNESS CENTER, PLLC

Provider Business Mailing Address
First Line	:	1957 N FAIRFIELD AVE APT 3L
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2359
Country	:	US
Telephone Number	:	763-732-9681
Fax Number	:

Provider Business Practice Location Address
First Line	:	1957 N FAIRFIELD AVE APT 3L
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2359
Country	:	US
Telephone Number	:	763-732-9681
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST/MANAGER
Name	:	DR. MELISSA MEINEN
Credential	:	PSY.D.
Telephone Number	:	708-540-3276

Provider Enumeration Date	:	05/23/2021
Last Update Date	:	05/23/2021

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