MEDICARE: MALISHA WEBBER

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	178012653	IL
2	101YM0800X	Mental Health Counselor	180015052	IL
3	101YP2500X	Professional Counselor	178012653	IL
4	171M00000X	Case Manager/Care Coordinator	178012653
5	101YP2500X	Professional Counselor	180015052	IL

General Provider Information

NPI Number	:	1518471960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALISHA WEBBER

Provider Business Mailing Address
First Line	:	4247 S PRAIRIE AVE APT 3N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3283
Country	:	US
Telephone Number	:	630-903-4789
Fax Number	:

Provider Business Practice Location Address
First Line	:	4247 S PRAIRIE AVE APT 3N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3283
Country	:	US
Telephone Number	:	630-903-4789
Fax Number	:	630-903-4789

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

Provider Enumeration Date	:	11/21/2017
Last Update Date	:	04/11/2023

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Directions to “ MALISHA WEBBER ” Practice Location

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