MEDICARE: ELIZABETH K HAFERKAMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	178.012455	IL

General Provider Information

NPI Number	:	1003455312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH K HAFERKAMP

Provider Business Mailing Address
First Line	:	2801 BROCKWAY ST
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-7429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 E OAKTON ST
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-4881
Country	:	US
Telephone Number	:	847-956-7912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2020
Last Update Date	:	01/03/2020

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