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NPI Code Detail

MEDICARE: JENINE LEE CHILES PSY.D.

MEDICARE: JENINE LEE CHILES 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
1103TC0700XClinical Psychologist071-006017IL

General Provider Information

NPI Number : 1316168412
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENINE LEE CHILES PSY.D.
Provider Business Mailing Address
First Line : 2613 W SUPERIOR ST
Second Line : APT. #1
City : CHICAGO
State : IL
Zip : 60612-1110
Country : US
Telephone Number : 773-252-7199
Fax Number :
Provider Business Practice Location Address
First Line : 641 W 63RD ST
Second Line : SPECIALTY CLINIC, LOWER LEVEL
City : CHICAGO
State : IL
Zip : 60621-2032
Country : US
Telephone Number : 312-745-0662
Fax Number : 312-747-5275
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 07/08/2007

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