MEDICARE: EMDR GROUP OF CHICAGO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QH0100X	Health Service Clinic/Center
3	261QM0850X	Adult Mental Health Clinic/Center
4	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1194670430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMDR GROUP OF CHICAGO LLC

Provider Business Mailing Address
First Line	:	4051 N MAPLEWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 N RAVENSWOOD AVE # 254
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5651
Country	:	US
Telephone Number	:	773-837-6096
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRIANNA ZIELKE
Credential	:
Telephone Number	:	773-837-6096

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “EMDR GROUP OF CHICAGO LLC ” Practice Location

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