MEDICARE: NADIA PERSUN 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	180006620	IL

General Provider Information

NPI Number	:	1871797613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADIA PERSUN LCPC

Provider Business Mailing Address
First Line	:	2132 DEEP WATER LN
Second Line	:	STE 240
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-8565
Country	:	US
Telephone Number	:	630-217-9911
Fax Number	:	630-596-8636

Provider Business Practice Location Address
First Line	:	2132 DEEP WATER LN
Second Line	:	STE 240
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-8565
Country	:	US
Telephone Number	:	630-217-9911
Fax Number	:	630-596-8636

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	04/23/2016

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