Individual
MELISSA HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
938 W NELSON ST, CHICAGO, IL 60657-6704
(773) 296-3220
Mailing address
938 W NELSON ST, CHICAGO, IL 60657-6704
(773) 296-3220
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
3380-57
WI
103TC0700X
Clinical Psychologist
Primary
071.009398
IL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
08/18/2010
Last updated
11/24/2020
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