MEDICARE: STEVE R MEISNER LCPC

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	251S00000X	Community/Behavioral Health Agency	180-002979	IL

General Provider Information

NPI Number	:	1528180940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVE R MEISNER LCPC

Provider Business Mailing Address
First Line	:	1770 S RANDALL RD
Second Line	:	STE. A, #222
City	:	GENEVA
State	:	IL
Zip	:	60134-4646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 WOODLAND CIR
Second Line	:
City	:	NORTH AURORA
State	:	IL
Zip	:	60542-3323
Country	:	US
Telephone Number	:	630-802-2901
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVE MEISNER
Credential	:	MS, LCPC
Telephone Number	:	630-802-2901

Provider Enumeration Date	:	04/05/2007
Last Update Date	:	07/23/2008

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