MEDICARE: SCOTT CONKLIN 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	101Y00000X	Counselor	180008996	IL

General Provider Information

NPI Number	:	1730410077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT CONKLIN LCPC

Provider Business Mailing Address
First Line	:	636 CHURCH ST STE 420
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4580
Country	:	US
Telephone Number	:	312-869-4897
Fax Number	:

Provider Business Practice Location Address
First Line	:	636 CHURCH ST STE 420
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4580
Country	:	US
Telephone Number	:	312-869-4897
Fax Number	:

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

Provider Enumeration Date	:	01/27/2010
Last Update Date	:	09/11/2020

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Directions to “ SCOTT CONKLIN LCPC” Practice Location

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