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NPI Code Detail

MEDICARE: MRS. MICHELE LYNN PETERSMARK LCPC

MEDICARE: MRS. MICHELE LYNN PETERSMARK LCPC
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 Counselor
2101YP2500XProfessional Counselor180004990IL

General Provider Information

NPI Number : 1427103498
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELE LYNN PETERSMARK LCPC
Provider Business Mailing Address
First Line : 1335 N MILL ST STE 100
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-2047
Country : US
Telephone Number : 630-646-8000
Fax Number :
Provider Business Practice Location Address
First Line : 1335 N MILL ST STE 100
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-2047
Country : US
Telephone Number : 630-646-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2007
Last Update Date : 05/13/2021

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Directions to “ MRS. MICHELE LYNN PETERSMARK LCPC” Practice Location

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