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NPI Code Detail

MEDICARE: MS. CHANTAL PICO MA

MEDICARE: MS. CHANTAL PICO MA
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 Counselor180011900IL

General Provider Information

NPI Number : 1609346410
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHANTAL PICO MA
Provider Business Mailing Address
First Line : 2151 EMILY DR
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60490-4927
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4740 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4689
Country : US
Telephone Number : 773-769-0205
Fax Number : 773-765-0801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2018
Last Update Date : 12/05/2018

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