MEDICARE: MR. JEFFREY L. VANDENBUSSCHE MA, LCPC

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	101YP2500X	Professional Counselor	178.008984	IL
2	106H00000X	Marriage & Family Therapist	208.000303	IL
3	101YP2500X	Professional Counselor	180.011982	IL

General Provider Information

NPI Number	:	1063751980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY L. VANDENBUSSCHE MA, LCPC

Provider Business Mailing Address
First Line	:	1242 W WINONA ST UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2908
Country	:	US
Telephone Number	:	773-271-1312
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 S MICHIGAN AVE STE 928
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-1399
Country	:	US
Telephone Number	:	312-248-3190
Fax Number	:

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

Provider Enumeration Date	:	02/13/2013
Last Update Date	:	10/25/2023

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