MEDICARE: STUDIO FOR CHANGE

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	103TC0700X	Clinical Psychologist	071-005837	IL

General Provider Information

NPI Number	:	1114180148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STUDIO FOR CHANGE

Provider Business Mailing Address
First Line	:	2835 N SHEFFIELD AVE STE 310
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5084
Country	:	US
Telephone Number	:	773-281-8130
Fax Number	:	773-281-7150

Provider Business Practice Location Address
First Line	:	2835 N SHEFFIELD AVE STE 310
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5084
Country	:	US
Telephone Number	:	773-281-8130
Fax Number	:	773-281-7150

Authorized Official
Title or Position	:	OWNER
Name	:	JULIA M RAHN
Credential	:	PH.D.
Telephone Number	:	773-281-8130

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	06/11/2015

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Directions to “STUDIO FOR CHANGE ” Practice Location

Language	Start Address	Practice Location

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