Provider Demographics
NPI:1316033392
Name:SEMMELHACK, DIANA J (PSYD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:J
Last Name:SEMMELHACK
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2230
Mailing Address - Country:US
Mailing Address - Phone:847-491-0165
Mailing Address - Fax:847-492-9463
Practice Address - Street 1:1919 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2230
Practice Address - Country:US
Practice Address - Phone:847-491-0165
Practice Address - Fax:847-492-9463
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006302103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200167Medicare PIN
IL209212Medicare PIN
ILP00378003Medicare PIN
IL213198Medicare PIN