MEDICARE: JESSICA FREILICH'S PSYCHOLOGY PRACTICE

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

General Provider Information

NPI Number	:	1518641943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA FREILICH'S PSYCHOLOGY PRACTICE

Provider Business Mailing Address
First Line	:	2815 N RICHMOND ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-7704
Country	:	US
Telephone Number	:	847-616-8767
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 N RICHMOND ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-7704
Country	:	US
Telephone Number	:	847-616-8767
Fax Number	:

Authorized Official
Title or Position	:	BILLING
Name	:	ROBERT FOREMAN
Credential	:
Telephone Number	:	630-313-0069

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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