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General NPI Number Information
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NPI Number | 1750857942
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Entity Type | Individual
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Provider Name | MYRNA PLEDGER LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 10/16/2018
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Provider Practice Location Address
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Address Line | 259 W. 104TH PL.
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City | CHICAGO
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State | IL
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Zip | 60628
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Country | US
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Telephone | 708-357-9495
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Fax |
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Provider Business Mailing Address
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Address Line | 259 W 104TH PL
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City | CHICAGO
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State | IL
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Zip | 60628-2513
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Country | US
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Telephone | 708-357-9495
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 180006251
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License Number State | IL
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