MEDICARE: PERINATAL MENTAL HEALTH CENTER OF CHICAGO PLLC

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	:	1043085962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERINATAL MENTAL HEALTH CENTER OF CHICAGO PLLC

Provider Business Mailing Address
First Line	:	3759 N RAVENSWOOD AVE STE 226C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4088
Country	:	US
Telephone Number	:	312-487-1771
Fax Number	:

Provider Business Practice Location Address
First Line	:	3759 N RAVENSWOOD AVE STE 226C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4088
Country	:	US
Telephone Number	:	312-487-1771
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	JENNIFER KOST
Credential	:
Telephone Number	:	312-487-1771

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	04/17/2024

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