MEDICARE: IU-LUEN JENG LCPC, ATR

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	178.007475	IL
2	101YM0800X	Mental Health Counselor	180.008718	IL

General Provider Information

NPI Number	:	1720414055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IU-LUEN JENG LCPC, ATR

Provider Business Mailing Address
First Line	:	3934 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2432
Country	:	US
Telephone Number	:	773-549-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3934 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2432
Country	:	US
Telephone Number	:	773-549-1700
Fax Number	:

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

Provider Enumeration Date	:	09/18/2013
Last Update Date	:	01/26/2022

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