MEDICARE: MS. JANET S. MIGDOW MA,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	101YM0800X	Mental Health Counselor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001608158	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1689684334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANET S. MIGDOW MA,LCPC

Provider Business Mailing Address
First Line	:	3232 W VICTORIA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3624
Country	:	US
Telephone Number	:	773-463-1901
Fax Number	:	773-463-7955

Provider Business Practice Location Address
First Line	:	3232 W VICTORIA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3624
Country	:	US
Telephone Number	:	773-463-1901
Fax Number	:	773-463-7955

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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