MEDICARE: MS. PATRICIA PALDEN

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	374J00000X	Doula

General Provider Information

NPI Number	:	1154679041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA PALDEN

Provider Business Mailing Address
First Line	:	1741 W COLUMBIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4005
Country	:	US
Telephone Number	:	773-458-6354
Fax Number	:	773-262-8191

Provider Business Practice Location Address
First Line	:	1741 W COLUMBIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4005
Country	:	US
Telephone Number	:	773-458-6354
Fax Number	:

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

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	08/27/2012

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