MEDICARE: MEIER CLINICS OF ILLINOIS, 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

General Provider Information

NPI Number	:	1679529283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEIER CLINICS OF ILLINOIS, P.C.

Provider Business Mailing Address
First Line	:	2100 MANCHESTER RD
Second Line	:	SUITE 1510
City	:	WHEATON
State	:	IL
Zip	:	60187-4579
Country	:	US
Telephone Number	:	630-653-1717
Fax Number	:	630-653-1025

Provider Business Practice Location Address
First Line	:	180 N MICHIGAN AVE
Second Line	:	SUITE 2408
City	:	CHICAGO
State	:	IL
Zip	:	60601-7401
Country	:	US
Telephone Number	:	630-653-1717
Fax Number	:	630-653-1025

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	HEATHER GANDY
Credential	:
Telephone Number	:	630-653-1717

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	01/30/2008

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