MEDICARE: MS. HAN NGOC NGUYEN

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
2	103K00000X	Behavior Analyst	1-22-60877

General Provider Information

NPI Number	:	1790336378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HAN NGOC NGUYEN

Provider Business Mailing Address
First Line	:	111 N COUNTY FARM RD
Second Line	:
City	:	WHEATON
State	:	IL
Zip	:	60187-3977
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11301 S HARLEM AVE
Second Line	:
City	:	WORTH
State	:	IL
Zip	:	60482-2001
Country	:	US
Telephone Number	:	866-273-8060
Fax Number	:

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

Provider Enumeration Date	:	09/24/2019
Last Update Date	:	09/05/2022

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