MEDICARE: ALEXIS E SANTIAGO LPC

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	178.017737	IL

General Provider Information

NPI Number	:	1982356887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS E SANTIAGO LPC

Provider Business Mailing Address
First Line	:	2600 S MICHIGAN AVE STE 309
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-0049
Country	:	US
Telephone Number	:	773-234-8779
Fax Number	:	773-496-0494

Provider Business Practice Location Address
First Line	:	2600 S MICHIGAN AVE STE 309
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-0049
Country	:	US
Telephone Number	:	773-234-8779
Fax Number	:	773-496-0494

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

Provider Enumeration Date	:	01/21/2022
Last Update Date	:	01/24/2022

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