MEDICARE: KATELYN KIERA DANIELS 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	178.018171	IL

General Provider Information

NPI Number	:	1588421135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN KIERA DANIELS LPC

Provider Business Mailing Address
First Line	:	2139 W MADISON ST # 505
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2307
Country	:	US
Telephone Number	:	228-596-2419
Fax Number	:

Provider Business Practice Location Address
First Line	:	566 W LAKE ST STE 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-1413
Country	:	US
Telephone Number	:	312-525-8887
Fax Number	:

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

Provider Enumeration Date	:	02/29/2024
Last Update Date	:	02/29/2024

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