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NPI Code Detail

MEDICARE: JAMISON KIDD LPC

MEDICARE: JAMISON KIDD 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
1101YP2500XProfessional Counselor013024IL

General Provider Information

NPI Number : 1598367872
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMISON KIDD LPC
Provider Business Mailing Address
First Line : 3660 N LAKE SHORE DR STE 201
Second Line :
City : CHICAGO
State : IL
Zip : 60613-5302
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3660 N LAKE SHORE DR STE 201
Second Line :
City : CHICAGO
State : IL
Zip : 60613-5302
Country : US
Telephone Number : 773-759-5126
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2020
Last Update Date : 11/12/2020

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