MEDICARE: JEFFREY MICHAEL KRAFT MS

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	106H00000X	Marriage & Family Therapist	166.001289	IL

General Provider Information

NPI Number	:	1184280257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY MICHAEL KRAFT MS

Provider Business Mailing Address
First Line	:	25 E WASHINGTON ST STE 1021
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-1710
Country	:	US
Telephone Number	:	563-495-5746
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 E WASHINGTON ST STE 1021
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-1710
Country	:	US
Telephone Number	:	563-495-5746
Fax Number	:

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

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	06/16/2021

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