MEDICARE: DAVID ALLEN HONGISTO 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	24127	IL

General Provider Information

NPI Number	:	1710414792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ALLEN HONGISTO CADC

Provider Business Mailing Address
First Line	:	4862 N KENMORE AVE APT 1N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3753
Country	:	US
Telephone Number	:	312-953-6456
Fax Number	:

Provider Business Practice Location Address
First Line	:	4750 N SHERIDAN RD STE 500
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5095
Country	:	US
Telephone Number	:	773-751-4125
Fax Number	:

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

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	05/22/2017

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Directions to “ DAVID ALLEN HONGISTO CADC” Practice Location

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