MEDICARE: KATHERINE JONESCO LOWER LCPC, BC-DMT

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	225600000X	Dance Therapist
2	101YP2500X	Professional Counselor	180.008238	IL

General Provider Information

NPI Number	:	1720315773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE JONESCO LOWER LCPC, BC-DMT

Provider Business Mailing Address
First Line	:	3141 N SEMINARY AVE
Second Line	:	3
City	:	CHICAGO
State	:	IL
Zip	:	60657-3308
Country	:	US
Telephone Number	:	773-558-7237
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4208
Country	:	US
Telephone Number	:	773-281-8130
Fax Number	:	773-281-7150

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

Provider Enumeration Date	:	11/12/2009
Last Update Date	:	06/04/2013

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