MEDICARE: JEANA ALTMAN LCPC

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1633897	OTHER	IL	BCBS GROUP NUMBER
2	320078	OTHER	IL	VALUE OPTIONS GRP #

General Provider Information

NPI Number	:	1790887040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANA ALTMAN LCPC

Provider Business Mailing Address
First Line	:	1701 E. WOODFIELD ROAD
Second Line	:	SUITE 1000
City	:	SCHAUMBURG
State	:	IL
Zip	:	60173-5113
Country	:	US
Telephone Number	:	815-356-5050
Fax Number	:	847-240-2418

Provider Business Practice Location Address
First Line	:	390 E CONGRESS PKWY
Second Line	:	SUITE J
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-6202
Country	:	US
Telephone Number	:	815-356-5050
Fax Number	:	815-356-5094

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	07/08/2007

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