MEDICARE: DR. ERIN TELFORD PSY.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	103TC0700X	Clinical Psychologist	017007033	IL
2	103TC0700X	Clinical Psychologist	071007033	IL

General Provider Information

NPI Number	:	1265749121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIN TELFORD PSY.D.

Provider Business Mailing Address
First Line	:	5112 N OAKLEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-1830
Country	:	US
Telephone Number	:	773-453-6112
Fax Number	:

Provider Business Practice Location Address
First Line	:	4312 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1712
Country	:	US
Telephone Number	:	773-453-6112
Fax Number	:

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

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	07/14/2022

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