1598845422 NPI number — MRS. MICHELE ANTOINETTE NEALON WOODS PSYD

Table of content: MRS. MICHELE ANTOINETTE NEALON WOODS PSYD (NPI 1598845422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598845422 NPI number — MRS. MICHELE ANTOINETTE NEALON WOODS PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEALON WOODS
Provider First Name:
MICHELE
Provider Middle Name:
ANTOINETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOODS
Provider Other First Name:
MICHELE
Provider Other Middle Name:
ANTOINETTE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1598845422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PALOS BEHAVIORAL HEALTH PROFESSIONALS
Provider Second Line Business Mailing Address:
103011 S 104TH AVE SUITE 200
Provider Business Mailing Address City Name:
PALOS PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-448-3300
Provider Business Mailing Address Fax Number:
708-448-6772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PALOS BEHAVIORAL HEALTH PROFESSIONALS
Provider Second Line Business Practice Location Address:
103011 S 104TH AVE SUITE 200
Provider Business Practice Location Address City Name:
PALOS PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-448-3300
Provider Business Practice Location Address Fax Number:
708-448-6772
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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