MEDICARE: DR. JOHN MICHAEL PALEN M.S., PH.D.

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	1041C0700X	Clinical Social Worker	149001939	IL

General Provider Information

NPI Number	:	1710055520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL PALEN M.S., PH.D.

Provider Business Mailing Address
First Line	:	5445 N SHERIDAN RD APT 2415
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-7471
Country	:	US
Telephone Number	:	847-219-1877
Fax Number	:	847-965-4177

Provider Business Practice Location Address
First Line	:	5445 N SHERIDAN RD APT 2415
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-7471
Country	:	US
Telephone Number	:	847-219-1877
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	09/07/2021

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