MEDICARE: KATHERINE TESENSKY 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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1033647284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE TESENSKY M.A.

Provider Business Mailing Address
First Line	:	2970 N SHERIDAN RD APT 625
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5817
Country	:	US
Telephone Number	:	262-389-5378
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 E WASHINGTON ST STE 1025
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-1710
Country	:	US
Telephone Number	:	312-569-0285
Fax Number	:

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

Provider Enumeration Date	:	06/01/2017
Last Update Date	:	06/01/2017

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