MEDICARE: MR. LEE WICHMAN MA, LCPC

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	180004864	IL

General Provider Information

NPI Number	:	1003824897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEE WICHMAN MA, LCPC

Provider Business Mailing Address
First Line	:	655 W IRVING PARK RD
Second Line	:	SUITE 201
City	:	CHICAGO
State	:	IL
Zip	:	60613-3123
Country	:	US
Telephone Number	:	773-575-6373
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 W IRVING PARK RD
Second Line	:	SUITE 201
City	:	CHICAGO
State	:	IL
Zip	:	60613-3123
Country	:	US
Telephone Number	:	773-575-6373
Fax Number	:

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	02/07/2025

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