MEDICARE: ALYSSA SPADA

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	178.020027	IL

General Provider Information

NPI Number	:	1083464812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA SPADA

Provider Business Mailing Address
First Line	:	1000 LAKE ST APT 1314
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60301-1524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 E HURON ST STE 1300
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2999
Country	:	US
Telephone Number	:	312-757-4866
Fax Number	:

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

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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Directions to “ ALYSSA SPADA ” Practice Location

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