MEDICARE: MS. MARY SHESGREEN LMFT

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	106H00000X	Marriage & Family Therapist	166-000119	IL

General Provider Information

NPI Number	:	1477669919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY SHESGREEN LMFT

Provider Business Mailing Address
First Line	:	18 S 5TH ST
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-2177
Country	:	US
Telephone Number	:	630-262-9115
Fax Number	:	847-742-5128

Provider Business Practice Location Address
First Line	:	18 S 5TH ST
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-2177
Country	:	US
Telephone Number	:	630-262-9115
Fax Number	:	847-742-5128

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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