MEDICARE: RONALD KENT PHILLIPS MA

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	180.010068	IL
2	103T00000X	Psychologist	6301012652	MI

General Provider Information

NPI Number	:	1346489895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD KENT PHILLIPS MA

Provider Business Mailing Address
First Line	:	333 N. MICHIGAN AVENUE
Second Line	:	SUITE # 602
City	:	CHICAGO
State	:	IL
Zip	:	60601-1033
Country	:	US
Telephone Number	:	269-277-6657
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 N. MICHIGAN AVENUE
Second Line	:	SUITE # 602
City	:	CHICAGO
State	:	IL
Zip	:	60601-1033
Country	:	US
Telephone Number	:	269-277-6657
Fax Number	:

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

Provider Enumeration Date	:	02/06/2009
Last Update Date	:	05/19/2016

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