MEDICARE: DR. EVELYN SIEGEL KLEIN PHD

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		IL

General Provider Information

NPI Number	:	1265499164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVELYN SIEGEL KLEIN PHD

Provider Business Mailing Address
First Line	:	695 VERNON AVE
Second Line	:
City	:	GLENCOE
State	:	IL
Zip	:	60022-2602
Country	:	US
Telephone Number	:	847-835-4617
Fax Number	:

Provider Business Practice Location Address
First Line	:	695 VERNON AVE
Second Line	:
City	:	GLENCOE
State	:	IL
Zip	:	60022-2602
Country	:	US
Telephone Number	:	847-835-4617
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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