MEDICARE: ARDOR INTIMACY PLLC

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

General Provider Information

NPI Number	:	1255294260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARDOR INTIMACY PLLC

Provider Business Mailing Address
First Line	:	3139 N LINCOLN AVE STE 203
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3122
Country	:	US
Telephone Number	:	773-340-0203
Fax Number	:

Provider Business Practice Location Address
First Line	:	3139 N LINCOLN AVE STE 203
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3122
Country	:	US
Telephone Number	:	773-340-0203
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAUREN M KRPAN
Credential	:	LCPC
Telephone Number	:	847-682-6362

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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