MEDICARE: JUVENILE PROTECTIVE ASSOCIATION

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1609083815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUVENILE PROTECTIVE ASSOCIATION

Provider Business Mailing Address
First Line	:	1707 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-5501
Country	:	US
Telephone Number	:	312-440-1203
Fax Number	:	312-440-9563

Provider Business Practice Location Address
First Line	:	1707 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-5501
Country	:	US
Telephone Number	:	312-440-1203
Fax Number	:	312-440-9563

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL OPERATIONS
Name	:	MICHELE LANSING PALTER
Credential	:	LCSW
Telephone Number	:	312-698-6934

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	12/31/2020

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