MEDICARE: MS. CHANDRA DOCKERY M.A.

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	180006574	IL
2	101YP2500X	Professional Counselor	178002284	IL

General Provider Information

NPI Number	:	1952612145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHANDRA DOCKERY M.A.

Provider Business Mailing Address
First Line	:	12538 S YALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-7235
Country	:	US
Telephone Number	:	773-350-3749
Fax Number	:

Provider Business Practice Location Address
First Line	:	4314 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3514
Country	:	US
Telephone Number	:	773-350-3749
Fax Number	:

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

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	04/16/2025

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