MYLISSA MARY SLANE (NPI# 1932753035) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932753035 |
| Entity Type | Individual |
| Full Name | MYLISSA MARY SLANE |
| Credential | MS |
| Practice Address |
1200 Locust St Eldorado IL 62930-1723 |
| Mailing Address |
403 S Vicksburg St Apt E Marion IL 62959-1945 |
| Practice Telephone | 6182529036 |
| Mailing Telephone | 2158176849 |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2019-07-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers | ||
| Y | 103TS0200X |
Psychologist Specialization: School |
Behavioral Health & Social Service Providers |
| Street Address |
1200 LOCUST ST |
| City | ELDORADO |
| State | IL |
| Zip Code | 62930-1723 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992331813 | Flor Eldridge | Social Worker | 1200 Locust St, Eldorado, IL 62930-1723 | 2020-03-23 |
| 1386293900 | Asha K Unni | Psychologist | 1200 Locust St, Eldorado, IL 62930-1723 | 2019-09-06 |
| 1366097669 | Kelsey Atteberry | Psychologist | 1200 Locust St, Eldorado, IL 62930-1723 | 2019-08-05 |
| 1568017853 | Brooke Frazer | Psychologist | 1200 Locust St, Eldorado, IL 62930-1723 | 2019-08-05 |
| 1700342532 | Stress & Trauma Treatment Center, Inc. | Psychologist | 1200 Locust St, Eldorado, IL 62930-1723 | 2019-02-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164951802 | Jeanette Long X | Licensed Practical Nurse | 70 Alexander St, Eldorado, IL 62930 | 2017-06-07 |
| 1720510514 | Mckayla Addison Wren | Counselor | 1412 Us. 45n, Eldorado, IL 62930 | 2017-03-30 |
| 1407394901 | Melody Jo Smith | Licensed Practical Nurse | 2260 Raleigh Road, Eldorado, IL 62930 | 2017-02-03 |
| 1205250412 | Becks Long Term Care Pharmacy Inc | Pharmacy | 1413 Locust Street, Eldorado, IL 62930 | 2014-02-07 |
| 1346559283 | Danny Ray Phillips | Pharmacist | 1021 Us Hwy 45 North, Eldorado, IL 62930 | 2010-09-27 |
| 1447434477 | Elana Ruth Floyd-kennett | Social Worker | 1007 Route 45, Eldorado, IL 62930 | 2007-12-27 |
| 1417150376 | Luke Tyler Hall | Family Medicine | 1407 Locust St, Eldorado, IL 62930 | 2007-06-07 |
| 1134320039 | Eldorado Community Unit School District #4 | Local Education Agency (LEA) | 1040 Washington, Eldorado, IL 62930 | 2007-05-29 |
| 1013071026 | Marion Eye Centers Ltd. | Durable Medical Equipment & Medical Supplies | 1204 U.S. 45 N., Eldorado, IL 62930 | 2006-12-21 |
| 1467536557 | Debra Dian Rumsey | Licensed Practical Nurse | 607 4th Street, Eldorado Rural Health Clinic, Eldorado, IL 62930 | 2006-10-25 |
| Find all providers in zip 62930 | ||||
| Taxonomy Code | 103TS0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | School |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639632417 | Sarah Dickinson | Psychologist | 1412 Us Highway 45 N, Eldorado, IL 62930-3766 | 2019-04-09 |
| 1225599160 | Kathryn Bangs | Psychologist | 1412 Us Highway 45 N, Eldorado, IL 62930-3766 | 2019-03-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629679428 | Jessica Scharf | Psychologist | 8502 Bailey Rd # 63, Darien, IL 60561-5333 | 2020-11-06 |
| 1225637283 | Nicole Maggard | Psychologist | 137 Somerset Rd, Willowbrook, IL 60527-5470 | 2020-10-21 |
| 1033724232 | Shadequia Davis | Psychologist | 402 Richards St, Joliet, IL 60433-2218 | 2020-09-14 |
| 1043823123 | Lindsay Ann Franklin | Psychologist | 436 Coral Dr, Morton, IL 61550-8505 | 2020-08-28 |
| 1053923995 | Annie Biehl | Psychologist | 9750 Soreng Ave, Schiller Park, IL 60176-2105 | 2020-08-21 |
| 1811508989 | Caroline Cook | Psychologist | 246 S Fair Ave, Elmhurst, IL 60126-3600 | 2020-08-12 |
| 1760009955 | Tammy Carroll | Psychologist | 3801 Lake Ct, Trenton, IL 62293-2938 | 2020-07-03 |
| 1316568629 | Denisa Kerekes | Psychologist | 1536 Cedarwood Ct, Gurnee, IL 60031-6346 | 2020-04-28 |
| 1740801174 | Jessica Berlinghof | Psychologist | 220 Greenwood Dr, Round Lake Park, IL 60073-3444 | 2020-04-27 |
| 1861038200 | Ease of Mind Pllc | Psychologist | 10526 West Cermak Road, Suite 308aa, Westchester, IL 60154 | 2019-11-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.