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NPI Code Detail

MEDICARE: JENNA GREIG LPC

MEDICARE: JENNA GREIG LPC
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 Counselor178.018612IL

General Provider Information

NPI Number : 1487365060
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA GREIG LPC
Provider Business Mailing Address
First Line : 1555 RIDGE AVE APT 406
Second Line :
City : EVANSTON
State : IL
Zip : 60201-4174
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4621 N RAVENSWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4509
Country : US
Telephone Number : 312-438-3135
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2022
Last Update Date : 12/05/2022

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