MEDICARE: LESTER & ROSALIE ANIXTER CENTER

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1033871256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESTER & ROSALIE ANIXTER CENTER

Provider Business Mailing Address
First Line	:	6610 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4062
Country	:	US
Telephone Number	:	773-697-6529
Fax Number	:	312-312-9607

Provider Business Practice Location Address
First Line	:	6610 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4062
Country	:	US
Telephone Number	:	773-697-6529
Fax Number	:	312-312-9607

Authorized Official
Title or Position	:	CLAIMS ANALYST
Name	:	HEIDI OLKOWSKI
Credential	:
Telephone Number	:	773-697-6529

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	10/06/2021

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