MEDICARE: S. ANNE REDMOND L.C.P.C.

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001628070	OTHER	IL	BLUECROSSBLUESHIELD

General Provider Information

NPI Number	:	1609914654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	S. ANNE REDMOND L.C.P.C.

Provider Business Mailing Address
First Line	:	3351 N RACINE AVE
Second Line	:	UNIT B
City	:	CHICAGO
State	:	IL
Zip	:	60657-3238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5412 N CLARK ST
Second Line	:	SOUTH SUITE
City	:	CHICAGO
State	:	IL
Zip	:	60640-1223
Country	:	US
Telephone Number	:	773-580-2940
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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