=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689817587
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE ANNE CHICVARA PSYD, LCP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2009
-----------------------------------------------------
Last Update Date | 01/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20635 ABBEY WOODS CT N SUITE 207
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60423-3181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-473-2445
-----------------------------------------------------
Fax | 708-966-4363
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14923 DOGWOOD DR
-----------------------------------------------------
City | ORLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60462-3424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-473-2445
-----------------------------------------------------
Fax | 708-966-4363
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 178006050
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 071008055
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------