MEDICARE: DR. JOANNE L. PERPOLI PSY. D.

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	222Q00000X	Developmental Therapist
2	101YP2500X	Professional Counselor	180-004815	IL

General Provider Information

NPI Number	:	1477658177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANNE L. PERPOLI PSY. D.

Provider Business Mailing Address
First Line	:	436 W 31ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3136
Country	:	US
Telephone Number	:	708-945-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	436 W 31ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3136
Country	:	US
Telephone Number	:	708-945-8900
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	12/03/2019

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