MEDICARE: MRS. IEISHA JUANITA NORRIS 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
1	101YM0800X	Mental Health Counselor	180.012385	IL

General Provider Information

NPI Number	:	1447551767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IEISHA JUANITA NORRIS LCPC

Provider Business Mailing Address
First Line	:	1824 W 107TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-3326
Country	:	US
Telephone Number	:	773-574-4636
Fax Number	:

Provider Business Practice Location Address
First Line	:	1824 W 107TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-3326
Country	:	US
Telephone Number	:	773-574-4636
Fax Number	:

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

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	02/25/2021

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