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Individual

DR. TONYA MARIE MESTEMAKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PSY.D.

Contact information

Practice address
900 N SHORE DR, SUITE 174, LAKE BLUFF, IL 60044-2243
(773) 383-7700
(847) 615-1697
Mailing address
4443 N ALBANY AVE, CHICAGO, IL 60625-4501
(773) 383-7700

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
04932470
BCBS PROVIDER NUMBER
IL
Enumeration date
10/12/2006
Last updated
07/08/2007
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