MEDICARE: PENNY DROP THERAPY, INC

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

General Provider Information

NPI Number	:	1538848676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENNY DROP THERAPY, INC

Provider Business Mailing Address
First Line	:	PO BOX 592
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-0592
Country	:	US
Telephone Number	:	630-327-1167
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 ROOSEVELT RD STE A15
Second Line	:
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-5800
Country	:	US
Telephone Number	:	630-327-1167
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL THERAPIST
Name	:	STEPHANIE DRISCOLL
Credential	:	LCPC
Telephone Number	:	630-327-1167

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	07/17/2023

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Directions to “PENNY DROP THERAPY, INC ” Practice Location

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