MEDICARE: DONNA VINEGAR 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	101YP2500X	Professional Counselor	180.012380	IL

General Provider Information

NPI Number	:	1679128862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA VINEGAR LCPC

Provider Business Mailing Address
First Line	:	4800 S SAINT LAWRENCE AVE UNIT 2N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-1562
Country	:	US
Telephone Number	:	773-919-7598
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 W 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-5723
Country	:	US
Telephone Number	:	872-233-8207
Fax Number	:

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

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	08/05/2019

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