MEDICARE: JENNIFER FOLEY THERAPY

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	180.006510	IL

General Provider Information

NPI Number	:	1457886020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER FOLEY THERAPY

Provider Business Mailing Address
First Line	:	1460 N SANDBURG TER
Second Line	:	212
City	:	CHICAGO
State	:	IL
Zip	:	60610-8514
Country	:	US
Telephone Number	:	708-912-9565
Fax Number	:

Provider Business Practice Location Address
First Line	:	1460 N SANDBURG TER
Second Line	:	212
City	:	CHICAGO
State	:	IL
Zip	:	60610-8514
Country	:	US
Telephone Number	:	708-912-9565
Fax Number	:

Authorized Official
Title or Position	:	LCPC
Name	:	JENNIFER FOLEY
Credential	:	MA
Telephone Number	:	708-912-9565

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	04/20/2017

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