Individual
DR. LYSSA MENARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
445 E OHIO ST STE 304, CHICAGO, IL 60611-4675
(312) 404-9539
Mailing address
70 W HURON ST APT 2604, CHICAGO, IL 60654-3866
(312) 404-9539
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-006487
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SSN
—
01
—
071-006487
STATE LICENSE
IL
Enumeration date
10/24/2006
Last updated
05/21/2020
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