MEDICARE: MESPHINA KUDOWOR MA

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	101YM0800X	Mental Health Counselor	178.015525	IL

General Provider Information

NPI Number	:	1023666120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MESPHINA KUDOWOR MA

Provider Business Mailing Address
First Line	:	17 N DEARBORN ST FL 15
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-4310
Country	:	US
Telephone Number	:	312-890-1095
Fax Number	:

Provider Business Practice Location Address
First Line	:	1757 N KIMBALL AVE STE 202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4805
Country	:	US
Telephone Number	:	630-426-9238
Fax Number	:

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

Provider Enumeration Date	:	09/01/2019
Last Update Date	:	01/20/2026

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