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General NPI Number Information
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NPI Number | 1497110936
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Entity Type | Organization
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Legal Business Name | PAGONE PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 830 E HIGGINS RD SUITE 112
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4797
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Country | US
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Telephone | 773-339-7949
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Fax |
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Provider Business Mailing Address
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Address Line | 830 E HIGGINS RD SUITE 112
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4797
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Country | US
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Telephone | 773-339-7949
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JENNIFER J. PAGONE
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Credential | LCPC, NCC
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Telephone | 773-339-7949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180008212
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License Number State | IL
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