Individual
DR. SHANA D MITZEL NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY D
Contact information
Practice address
300 E ROOSEVELT RD, SUITE 105, WHEATON, IL 60187-1908
(847) 732-1704
Mailing address
300 E ROOSEVELT RD, SUITE 105, WHEATON, IL 60187-1908
(847) 732-1704
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071006921
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635721
BCBS
IL
Enumeration date
08/30/2006
Last updated
07/29/2016
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