MEDICARE: MR. ROBERT LEO NORMAN SR. M.A., LCPC, CADC

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	N655-0005-7710	IL

General Provider Information

NPI Number	:	1679642631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT LEO NORMAN SR. M.A., LCPC, CADC

Provider Business Mailing Address
First Line	:	826 MARY BYRNE DR
Second Line	:
City	:	SAUK VILLAGE
State	:	IL
Zip	:	60411-5080
Country	:	US
Telephone Number	:	708-705-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	826 MARY BYRNE DR
Second Line	:
City	:	SAUK VILLAGE
State	:	IL
Zip	:	60411-5080
Country	:	US
Telephone Number	:	708-705-2211
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	10/29/2007

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