MEDICARE: DR. JULIA MICHELE RAHN 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	103TC0700X	Clinical Psychologist	071-005837	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0021623225	OTHER	IL	BC/BS PROVIDER NUMBER

General Provider Information

NPI Number	:	1902835705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIA MICHELE RAHN PH.D.

Provider Business Mailing Address
First Line	:	3139 N LINCOLN AVE STE 210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3122
Country	:	US
Telephone Number	:	773-281-8130
Fax Number	:	773-281-7150

Provider Business Practice Location Address
First Line	:	3139 N LINCOLN AVE STE 210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3122
Country	:	US
Telephone Number	:	773-281-8130
Fax Number	:	773-281-7150

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	07/08/2007

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