MEDICARE: KENNETH MICHAEL ANDJULIS 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

General Provider Information

NPI Number	:	1770820573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH MICHAEL ANDJULIS LCPC

Provider Business Mailing Address
First Line	:	5701 N ASHLAND AVE
Second Line	:	SUITE 205-A
City	:	CHICAGO
State	:	IL
Zip	:	60660-4027
Country	:	US
Telephone Number	:	312-806-6918
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 N ASHLAND AVE
Second Line	:	SUITE 205-A
City	:	CHICAGO
State	:	IL
Zip	:	60660-4027
Country	:	US
Telephone Number	:	312-806-6918
Fax Number	:

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

Provider Enumeration Date	:	01/14/2013
Last Update Date	:	01/14/2013

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