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NPI Code Detail

MEDICARE: RACHEL MENOR CADC

MEDICARE: RACHEL MENOR CADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1528679446
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL MENOR CADC
Provider Business Mailing Address
First Line : 12145 WESTERN AVE
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-1387
Country : US
Telephone Number : 773-537-3972
Fax Number :
Provider Business Practice Location Address
First Line : 12145 WESTERN AVE
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-1387
Country : US
Telephone Number : 773-537-3972
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2020
Last Update Date : 10/07/2021

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Directions to “ RACHEL MENOR CADC” Practice Location

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