MEDICARE: THE IMPACT OF THERAPY L.L.C.

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1548033244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE IMPACT OF THERAPY L.L.C.

Provider Business Mailing Address
First Line	:	10310 W YORK HOUSE RD
Second Line	:
City	:	BEACH PARK
State	:	IL
Zip	:	60087-2402
Country	:	US
Telephone Number	:	847-323-6213
Fax Number	:

Provider Business Practice Location Address
First Line	:	10310 W YORK HOUSE RD
Second Line	:
City	:	BEACH PARK
State	:	IL
Zip	:	60087-2402
Country	:	US
Telephone Number	:	847-323-6213
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	JONATHAN ARENAS
Credential	:
Telephone Number	:	847-323-6213

Provider Enumeration Date	:	11/03/2023
Last Update Date	:	11/10/2023

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