Provider Demographics
NPI:1366418857
Name:MCNEELY, SHARON LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LYNN
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34421
Mailing Address - Street 2:6315 W. ADDISON STREET
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-0421
Mailing Address - Country:US
Mailing Address - Phone:773-736-2340
Mailing Address - Fax:773-736-7033
Practice Address - Street 1:6315 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4002
Practice Address - Country:US
Practice Address - Phone:773-736-2340
Practice Address - Fax:773-736-7033
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1673299OtherBLUE CROSS PROVIDER NUMBE