MEDICARE: THERESE FITZPATRICK

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	101YM0800X	Mental Health Counselor	149.01773	IL

General Provider Information

NPI Number	:	1215310479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESE FITZPATRICK

Provider Business Mailing Address
First Line	:	7503 MADISON ST
Second Line	:
City	:	FOREST PARK
State	:	IL
Zip	:	60130-1481
Country	:	US
Telephone Number	:	708-657-5320
Fax Number	:

Provider Business Practice Location Address
First Line	:	7503 MADISON ST
Second Line	:
City	:	FOREST PARK
State	:	IL
Zip	:	60130-1481
Country	:	US
Telephone Number	:	708-657-5320
Fax Number	:

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

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	07/07/2015

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Directions to “ THERESE FITZPATRICK ” Practice Location

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