MEDICARE: ANNA JANKOWSKA MA LCPC CEAP SAP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	15116	IL
2	101YM0800X	Mental Health Counselor	180-005383	IL

General Provider Information

NPI Number	:	1598843526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA JANKOWSKA MA LCPC CEAP SAP

Provider Business Mailing Address
First Line	:	4515 N MILWAUKEE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630
Country	:	US
Telephone Number	:	773-777-6767
Fax Number	:	773-777-7274

Provider Business Practice Location Address
First Line	:	4515 N MILWAUKEE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630
Country	:	US
Telephone Number	:	773-777-6767
Fax Number	:	773-777-7274

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/28/2013

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