MEDICARE: CRAIG H EARNEST PH.D.

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	103T00000X	Psychologist		IL

General Provider Information

NPI Number	:	1255353413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG H EARNEST PH.D.

Provider Business Mailing Address
First Line	:	947 COMMONWEALTH COURT
Second Line	:	4B
City	:	VERNON HILLS
State	:	IL
Zip	:	60061
Country	:	US
Telephone Number	:	773-777-7413
Fax Number	:

Provider Business Practice Location Address
First Line	:	4835 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2719
Country	:	US
Telephone Number	:	773-777-7413
Fax Number	:

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	01/31/2008

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