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NPI Code Detail

MEDICARE: JANELLE OTERO

MEDICARE: JANELLE OTERO
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 Counselor

General Provider Information

NPI Number : 1629697578
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANELLE OTERO
Provider Business Mailing Address
First Line : 3020 N KOLMAR AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60641-5216
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2600 RIDGELAND AVE
Second Line :
City : BERWYN
State : IL
Zip : 60402-2725
Country : US
Telephone Number : 708-317-5926
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2020
Last Update Date : 04/10/2020

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Directions to “ JANELLE OTERO ” Practice Location

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