MEDICARE: LISA M NARDI, PC

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	251S00000X	Community/Behavioral Health Agency	180006980	IL

General Provider Information

NPI Number	:	1548653769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA M NARDI, PC

Provider Business Mailing Address
First Line	:	14475 JOHN HUMPHREY DR
Second Line	:	SUITE I
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-6205
Country	:	US
Telephone Number	:	815-450-9731
Fax Number	:

Provider Business Practice Location Address
First Line	:	14475 JOHN HUMPHREY DR
Second Line	:	SUITE I
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-6205
Country	:	US
Telephone Number	:	815-450-9731
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST, OWNER
Name	:	LISA MARIA NARDI
Credential	:	LCPC
Telephone Number	:	815-450-9731

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	03/12/2015

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