MEDICARE: MRS. DONNA J. PUFAHL L.C.P.C.

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	101Y00000X	Counselor	180-001147	IL

General Provider Information

NPI Number	:	1124272026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA J. PUFAHL L.C.P.C.

Provider Business Mailing Address
First Line	:	5419 BULL VALLEY RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-7410
Country	:	US
Telephone Number	:	815-353-8117
Fax Number	:	262-877-3933

Provider Business Practice Location Address
First Line	:	5419 BULL VALLEY RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-7410
Country	:	US
Telephone Number	:	815-353-8117
Fax Number	:	262-877-3933

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

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	11/05/2008

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