MEDICARE: JESSICA GARFIELD L.P.C

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	101YP2500X	Professional Counselor	178.006114	IL

General Provider Information

NPI Number	:	1447576426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GARFIELD L.P.C

Provider Business Mailing Address
First Line	:	441 W BARRY AVE, 524
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-6065
Country	:	US
Telephone Number	:	773-801-9696
Fax Number	:

Provider Business Practice Location Address
First Line	:	10343 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-2410
Country	:	US
Telephone Number	:	773-801-9696
Fax Number	:

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	04/15/2010

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