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NPI Code Detail

MEDICARE: KHADIJA MANZOOR

MEDICARE: KHADIJA MANZOOR
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
1101YM0800XMental Health Counselor500642IL

General Provider Information

NPI Number : 1609544782
Entity Type Code : Individual
Provider Name (Legal Business Name) : KHADIJA MANZOOR
Provider Business Mailing Address
First Line : 5816 LINCOLN AVE
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-3344
Country : US
Telephone Number : 312-813-8842
Fax Number :
Provider Business Practice Location Address
First Line : 501 DAVIS ST
Second Line :
City : EVANSTON
State : IL
Zip : 60201-4619
Country : US
Telephone Number : 312-815-9660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2021
Last Update Date : 09/02/2021

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Directions to “ KHADIJA MANZOOR ” Practice Location

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