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NPI Code Detail

MEDICARE: ANGELICA CORNEJO LCPC

MEDICARE: ANGELICA CORNEJO LCPC
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
1101YP2500XProfessional Counselor180011545IL

General Provider Information

NPI Number : 1568834158
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELICA CORNEJO LCPC
Provider Business Mailing Address
First Line : 1318 W 107TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60643-3632
Country : US
Telephone Number : 773-331-4029
Fax Number :
Provider Business Practice Location Address
First Line : 10725 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60643-3217
Country : US
Telephone Number : 773-270-1042
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2015
Last Update Date : 12/08/2022

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Directions to “ ANGELICA CORNEJO LCPC” Practice Location

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