MEDICARE: EWS OF ILLINOIS INC.

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	101YP2500X	Professional Counselor	180006532	IL

General Provider Information

NPI Number	:	1740511211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EWS OF ILLINOIS INC.

Provider Business Mailing Address
First Line	:	4709 KINGS WAY N
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-3215
Country	:	US
Telephone Number	:	847-651-8489
Fax Number	:

Provider Business Practice Location Address
First Line	:	34121 N US HIGHWAY 45
Second Line	:	SUITE 209
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-1768
Country	:	US
Telephone Number	:	847-651-8489
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EDWARD WALTER SENKPEIL
Credential	:	M.A.
Telephone Number	:	847-651-8489

Provider Enumeration Date	:	01/23/2010
Last Update Date	:	11/10/2011

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