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NPI Code Detail

MEDICARE: MS. IVONE GUTIERREZ

MEDICARE: MS. IVONE GUTIERREZ
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
1101YM0800XMental Health Counselor180010142IL

General Provider Information

NPI Number : 1255614228
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. IVONE GUTIERREZ
Provider Business Mailing Address
First Line : 401 N MICHIGAN AVE STE 1200
Second Line :
City : CHICAGO
State : IL
Zip : 60611-4264
Country : US
Telephone Number : 773-741-9531
Fax Number : 773-825-8152
Provider Business Practice Location Address
First Line : 401 N MICHIGAN AVE STE 1200
Second Line :
City : CHICAGO
State : IL
Zip : 60611-4264
Country : US
Telephone Number : 773-741-9531
Fax Number : 773-825-8152
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2011
Last Update Date : 07/01/2024

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