MEDICARE: JAMIE BRAGG LPC

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	178.022312	IL

General Provider Information

NPI Number	:	1740145937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE BRAGG LPC

Provider Business Mailing Address
First Line	:	1700 W IRVING PARK RD STE 104
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2596
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4043 N RAVENSWOOD AVE STE 309
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5683
Country	:	US
Telephone Number	:	312-967-9291
Fax Number	:

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

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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