MEDICARE: MS. LAUREN NICOLE WESLEY M.A.

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1033460506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN NICOLE WESLEY M.A.

Provider Business Mailing Address
First Line	:	4548 S PRAIRIE AVE
Second Line	:	UNIT 3
City	:	CHICAGO
State	:	IL
Zip	:	60653-3912
Country	:	US
Telephone Number	:	404-563-6910
Fax Number	:

Provider Business Practice Location Address
First Line	:	2251 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-6002
Country	:	US
Telephone Number	:	404-563-6910
Fax Number	:

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

Provider Enumeration Date	:	09/25/2012
Last Update Date	:	09/25/2012

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