MEDICARE: MARK WOODWARD MS, LCPC

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	101YP2500X	Professional Counselor	180-002973	IL

General Provider Information

NPI Number	:	1194835959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK WOODWARD MS, LCPC

Provider Business Mailing Address
First Line	:	5455 N SHERIDAN RD
Second Line	:	#2211
City	:	CHICAGO
State	:	IL
Zip	:	60640-1958
Country	:	US
Telephone Number	:	312-343-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 E. WASHINGTON ST.
Second Line	:	SUITE 1925
City	:	CHICAGO
State	:	IL
Zip	:	60602
Country	:	US
Telephone Number	:	312-343-2424
Fax Number	:	773-944-0233

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	01/31/2020

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