MEDICARE: ASSOCIATE'S FOR LIFE'S CHALLENGES

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		IL

General Provider Information

NPI Number	:	1902955164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATE'S FOR LIFE'S CHALLENGES

Provider Business Mailing Address
First Line	:	900 W JACKSON BLVD
Second Line	:	SUITE 7 WEST
City	:	CHICAGO
State	:	IL
Zip	:	60607-3024
Country	:	US
Telephone Number	:	312-455-8904
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 W JACKSON BLVD
Second Line	:	SUITE 7 WEST
City	:	CHICAGO
State	:	IL
Zip	:	60607-3024
Country	:	US
Telephone Number	:	312-455-8904
Fax Number	:

Authorized Official
Title or Position	:	PSY. D.
Name	:	DR. CAROLYN J. FRIEND
Credential	:
Telephone Number	:	312-455-8904

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/19/2007

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