MEDICARE: ROSARIO MARIA ELIZA WANGERIN MA

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	101Y00000X	Counselor	180010832	IL
2	101YP2500X	Professional Counselor	180010832	IL

General Provider Information

NPI Number	:	1568945814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSARIO MARIA ELIZA WANGERIN MA

Provider Business Mailing Address
First Line	:	6753 N NEWGARD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4279
Country	:	US
Telephone Number	:	847-902-8429
Fax Number	:

Provider Business Practice Location Address
First Line	:	6753 N NEWGARD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4279
Country	:	US
Telephone Number	:	847-902-8429
Fax Number	:

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

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	08/29/2024

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