MEDICARE: MS. GEORGETTE ELAINE LEPAGE MS, LCPC

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	101YP2500X	Professional Counselor	180000239	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01626639	OTHER	IL	BLUE CROSS

General Provider Information

NPI Number	:	1053490235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GEORGETTE ELAINE LEPAGE MS, LCPC

Provider Business Mailing Address
First Line	:	3660 N LAKE SHORE DRIVE, UNIT 3010
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5314
Country	:	US
Telephone Number	:	708-373-1952
Fax Number	:	847-675-7167

Provider Business Practice Location Address
First Line	:	3660 N LAKE SHORE DRIVE, UNIT 3010
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5314
Country	:	US
Telephone Number	:	708-373-1952
Fax Number	:	847-675-7167

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	12/04/2024

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