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NPI Code Detail

MEDICARE: KATHERINE MENA

MEDICARE: KATHERINE MENA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1700643459
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE MENA
Provider Business Mailing Address
First Line : 1949 W 21ST PL
Second Line :
City : CHICAGO
State : IL
Zip : 60608-4201
Country : US
Telephone Number : 312-723-6448
Fax Number :
Provider Business Practice Location Address
First Line : 2801 W HOWARD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60645-1228
Country : US
Telephone Number : 773-305-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/29/2024
Last Update Date : 08/08/2024

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Directions to “ KATHERINE MENA ” Practice Location

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