MEDICARE: HOLLY CORDRAY

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1265682207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY CORDRAY

Provider Business Mailing Address
First Line	:	4001 W DAYTON ST
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-8377
Country	:	US
Telephone Number	:	815-219-9352
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 W DAYTON ST
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-8377
Country	:	US
Telephone Number	:	815-219-9352
Fax Number	:

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

Provider Enumeration Date	:	09/26/2008
Last Update Date	:	04/29/2013

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Directions to “ HOLLY CORDRAY ” Practice Location

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