MEDICARE: MICHAELA CHRISTINE SIMON

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

General Provider Information

NPI Number	:	1457191983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA CHRISTINE SIMON

Provider Business Mailing Address
First Line	:	825 W CORNELIA AVE APT 1S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1737
Country	:	US
Telephone Number	:	419-367-3130
Fax Number	:

Provider Business Practice Location Address
First Line	:	1757 N KIMBALL AVE STE 202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4805
Country	:	US
Telephone Number	:	872-762-3673
Fax Number	:

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

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	06/18/2026

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