MEDICARE: INGRID G. GANIM LCPC

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	101YM0800X	Mental Health Counselor		IL

General Provider Information

NPI Number	:	1609993153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID G. GANIM LCPC

Provider Business Mailing Address
First Line	:	4600 N HARLEM AVE
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4714
Country	:	US
Telephone Number	:	708-867-6886
Fax Number	:	708-867-0207

Provider Business Practice Location Address
First Line	:	4600 N HARLEM AVE
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4714
Country	:	US
Telephone Number	:	708-867-6886
Fax Number	:	708-867-0207

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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