MEDICARE: COURTNEY NEWELL

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	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	222Q00000X	OTHER	IL	PROVIDER CONNECTIONS

General Provider Information

NPI Number	:	1790198091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY NEWELL

Provider Business Mailing Address
First Line	:	1823 W WABANSIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-1334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1823 W WABANSIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-1334
Country	:	US
Telephone Number	:	815-762-2140
Fax Number	:

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

Provider Enumeration Date	:	06/04/2014
Last Update Date	:	06/04/2014

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Directions to “ COURTNEY NEWELL ” Practice Location

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