MEDICARE: GRACE ALEXANDRA LINDAHL MA

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		IL

General Provider Information

NPI Number	:	1215713490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE ALEXANDRA LINDAHL MA

Provider Business Mailing Address
First Line	:	6149 N BROADWAY ST APT 515
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-1670
Country	:	US
Telephone Number	:	979-571-0378
Fax Number	:

Provider Business Practice Location Address
First Line	:	6321 N AVONDALE AVE STE 204
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-1961
Country	:	US
Telephone Number	:	773-774-4444
Fax Number	:

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

Provider Enumeration Date	:	09/05/2023
Last Update Date	:	09/05/2023

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Directions to “ GRACE ALEXANDRA LINDAHL MA” Practice Location

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