MEDICARE: KATHRYN BUSH 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	180002429	IL

General Provider Information

NPI Number	:	1689428120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN BUSH LCPC

Provider Business Mailing Address
First Line	:	2550 N LANCASTER LN
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-4919
Country	:	US
Telephone Number	:	847-356-6444
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 N LANCASTER LN
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-4919
Country	:	US
Telephone Number	:	847-356-6444
Fax Number	:

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

Provider Enumeration Date	:	04/12/2024
Last Update Date	:	03/11/2025

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