MEDICARE: BEATA D. JANKIEWICZ LCPC, CADC, ATR

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	180007257	IL

General Provider Information

NPI Number	:	1386941896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATA D. JANKIEWICZ LCPC, CADC, ATR

Provider Business Mailing Address
First Line	:	120 W GOLF RD
Second Line	:	SUITE 209
City	:	SCHAUMBURG
State	:	IL
Zip	:	60195-5179
Country	:	US
Telephone Number	:	708-228-9215
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 W GOLF RD
Second Line	:	SUITE 209
City	:	SCHAUMBURG
State	:	IL
Zip	:	60195-5179
Country	:	US
Telephone Number	:	708-228-9215
Fax Number	:

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

Provider Enumeration Date	:	02/17/2011
Last Update Date	:	04/26/2012

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