MEDICARE: MIND STANCE INC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1972152940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND STANCE INC

Provider Business Mailing Address
First Line	:	6423 N GREENVIEW AVE APT 3W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-6182
Country	:	US
Telephone Number	:	303-525-6697
Fax Number	:	872-231-0066

Provider Business Practice Location Address
First Line	:	5443 N BROADWAY ST FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1703
Country	:	US
Telephone Number	:	773-980-6505
Fax Number	:	872-231-0066

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	MS. JUDITH L WEIRAUCH
Credential	:	LCSW
Telephone Number	:	773-980-6505

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	03/25/2020

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Directions to “MIND STANCE INC ” Practice Location

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