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NPI Code Detail

MEDICARE: INDI POLOMA LPC

MEDICARE: INDI POLOMA LPC
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
1101YP2500XProfessional Counselor178023102IL

General Provider Information

NPI Number : 1356293831
Entity Type Code : Individual
Provider Name (Legal Business Name) : INDI POLOMA LPC
Provider Business Mailing Address
First Line : 2650 W MONTROSE AVE STE 102
Second Line :
City : CHICAGO
State : IL
Zip : 60618-1562
Country : US
Telephone Number : 773-377-5261
Fax Number : 872-813-4596
Provider Business Practice Location Address
First Line : 2650 W MONTROSE AVE STE 101
Second Line :
City : CHICAGO
State : IL
Zip : 60618-1562
Country : US
Telephone Number : 773-377-5261
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2026
Last Update Date : 06/13/2026

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Directions to “ INDI POLOMA LPC” Practice Location

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