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NPI Code Detail

MEDICARE: MS. LIZANNE B PHALEN MSW, PHD

MEDICARE:  MS. LIZANNE B PHALEN  MSW, PHD
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
1101YM0800XMental Health Counselor149004895IL

General Provider Information

NPI Number : 1033479092
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LIZANNE B PHALEN MSW, PHD
Provider Business Mailing Address
First Line : 5022 S GREENWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60615-2806
Country : US
Telephone Number : 773-494-0959
Fax Number :
Provider Business Practice Location Address
First Line : 5022 S GREENWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60615-2806
Country : US
Telephone Number : 773-494-0959
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2012
Last Update Date : 05/24/2012

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Directions to “ MS. LIZANNE B PHALEN MSW, PHD” Practice Location

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