Individual
MICHELLE MARIE LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2S504 ASHLEY DR, GLEN ELLYN, IL 60137-6939
(630) 696-2443
Mailing address
2S504 ASHLEY DR, GLEN ELLYN, IL 60137-6939
(630) 696-2443
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.007793
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071.007793
LICENSED PSYCHOLOGIST
IL
Enumeration date
09/19/2008
Last updated
06/11/2019
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