MEDICARE: MRS. BREEONA SMITH CADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		IL

General Provider Information

NPI Number	:	1225988033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BREEONA SMITH CADC

Provider Business Mailing Address
First Line	:	7047 S CALUMET AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-6536
Country	:	US
Telephone Number	:	773-912-7262
Fax Number	:

Provider Business Practice Location Address
First Line	:	7047 S CALUMET AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-6536
Country	:	US
Telephone Number	:	773-912-7262
Fax Number	:

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

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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