MEDICARE: SEEFELDT PSYCHOTHERAPY, PLLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1558106930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEEFELDT PSYCHOTHERAPY, PLLC

Provider Business Mailing Address
First Line	:	2051 N WHIPPLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 N MICHIGAN AVE STE 1025C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7999
Country	:	US
Telephone Number	:	414-467-8266
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	DR. ANDREA SEEFELDT
Credential	:	PSYD
Telephone Number	:	414-467-8266

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	06/27/2024

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