MEDICARE: ERICA HAYNES

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	178015570	IL

General Provider Information

NPI Number	:	1013557081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA HAYNES

Provider Business Mailing Address
First Line	:	2140 N WINCHESTER AVE APT 7
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3905
Country	:	US
Telephone Number	:	773-420-7113
Fax Number	:

Provider Business Practice Location Address
First Line	:	1142 W MADISON ST STE 302
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-2191
Country	:	US
Telephone Number	:	773-420-7113
Fax Number	:

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

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	01/08/2020

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Directions to “ ERICA HAYNES ” Practice Location

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