MEDICARE: JORDAN MARKIE TOIA LPC

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	178.014725	IL

General Provider Information

NPI Number	:	1073101986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN MARKIE TOIA LPC

Provider Business Mailing Address
First Line	:	1437 W BELLE PLAINE AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4844
Country	:	US
Telephone Number	:	847-977-1238
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1920
Country	:	US
Telephone Number	:	872-201-8326
Fax Number	:

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

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	01/06/2021

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