MEDICARE: KELLY NEUPERT LPC

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	178.018503	IL

General Provider Information

NPI Number	:	1568170710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY NEUPERT LPC

Provider Business Mailing Address
First Line	:	1427 W WRIGHTWOOD AVE UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1121
Country	:	US
Telephone Number	:	425-922-2544
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 E WASHINGTON ST STE 1613
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-1819
Country	:	US
Telephone Number	:	708-580-6940
Fax Number	:

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

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	11/09/2022

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