MEDICARE: JAMEE S KERKMAN 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	101YP2500X	Professional Counselor	180008412	IL
2	101YM0800X	Mental Health Counselor	180008412	IL

General Provider Information

NPI Number	:	1619274875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMEE S KERKMAN LCPC

Provider Business Mailing Address
First Line	:	PO BOX 841
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-0841
Country	:	US
Telephone Number	:	630-204-1101
Fax Number	:	630-618-3667

Provider Business Practice Location Address
First Line	:	123 W WASHINGTON ST
Second Line	:	SUITE 220
City	:	OSWEGO
State	:	IL
Zip	:	60543-8214
Country	:	US
Telephone Number	:	630-204-1101
Fax Number	:	630-618-3667

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

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	03/14/2013

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