MEDICARE: DANIELLE PORTIS

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		IL

General Provider Information

NPI Number	:	1205399425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE PORTIS

Provider Business Mailing Address
First Line	:	620 E 101ST PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-2242
Country	:	US
Telephone Number	:	773-946-0642
Fax Number	:

Provider Business Practice Location Address
First Line	:	1136 S DELANO CT W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-3740
Country	:	US
Telephone Number	:	773-946-0642
Fax Number	:

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

Provider Enumeration Date	:	04/14/2019
Last Update Date	:	04/14/2019

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Directions to “ DANIELLE PORTIS ” Practice Location

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