MEDICARE: WAX AND WANE THERAPY PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1336010594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAX AND WANE THERAPY PLLC

Provider Business Mailing Address
First Line	:	3131 N BERNARD ST APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6773
Country	:	US
Telephone Number	:	217-419-5232
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 N BERNARD ST APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6773
Country	:	US
Telephone Number	:	217-419-5232
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL THERAPIST
Name	:	SYDNEY RINEHART
Credential	:	LCSW
Telephone Number	:	217-419-5232

Provider Enumeration Date	:	09/12/2025
Last Update Date	:	09/12/2025

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