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NPI Code Detail

MEDICARE: MS. JANE ANN BENNETT-ELIAS LCPC

MEDICARE: MS. JANE ANN BENNETT-ELIAS 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
1101YP2500XProfessional Counselor180004275IL

General Provider Information

NPI Number : 1962530188
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JANE ANN BENNETT-ELIAS LCPC
Provider Business Mailing Address
First Line : 2650 W MONTROSE AVE STE 102
Second Line :
City : CHICAGO
State : IL
Zip : 60618-1562
Country : US
Telephone Number : 773-377-5261
Fax Number : 872-813-4596
Provider Business Practice Location Address
First Line : 2650 W MONTROSE AVE STE 102
Second Line :
City : CHICAGO
State : IL
Zip : 60618-1562
Country : US
Telephone Number : 773-377-5261
Fax Number : 872-813-4596
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 01/05/2024

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