MEDICARE: MRS. FELICIA ANNE DUDEK MS LCPC CADC

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	101Y00000X	Counselor		IL

General Provider Information

NPI Number	:	1194792705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FELICIA ANNE DUDEK MS LCPC CADC

Provider Business Mailing Address
First Line	:	4049 BORDEAUX DR
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-2139
Country	:	US
Telephone Number	:	847-729-3548
Fax Number	:	847-714-1596

Provider Business Practice Location Address
First Line	:	30 NORTH MICHIGAN AV
Second Line	:	ROOM 1926
City	:	CHICAGO
State	:	IL
Zip	:	60602-3615
Country	:	US
Telephone Number	:	847-729-3548
Fax Number	:	847-714-1597

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	07/08/2007

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