MEDICARE: KAROL ELIZABETH WEIGELT 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	180.011118	IL

General Provider Information

NPI Number	:	1013434463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAROL ELIZABETH WEIGELT LCPC

Provider Business Mailing Address
First Line	:	1218 W ADDISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3819
Country	:	US
Telephone Number	:	312-714-2566
Fax Number	:

Provider Business Practice Location Address
First Line	:	1218 W ADDISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3819
Country	:	US
Telephone Number	:	312-714-2566
Fax Number	:

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

Provider Enumeration Date	:	08/26/2017
Last Update Date	:	08/26/2017

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