MEDICARE: MS. MARCY FISCHGRUND 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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1649792011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCY FISCHGRUND MA

Provider Business Mailing Address
First Line	:	33 W ONTARIO ST APT 27G
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-7767
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 W WASHINGTON ST STE 1910
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-3176
Country	:	US
Telephone Number	:	224-377-9064
Fax Number	:

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

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	06/12/2020

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