MEDICARE: ANGELA FIELDHOUSE

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

General Provider Information

NPI Number	:	1235801168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA FIELDHOUSE

Provider Business Mailing Address
First Line	:	185 HERITAGE DR
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-8068
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 HERITAGE DR
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-8068
Country	:	US
Telephone Number	:	815-477-4727
Fax Number	:

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

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	09/29/2021

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Directions to “ ANGELA FIELDHOUSE ” Practice Location

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