MEDICARE: MISS JESSICA LAUREN KRAWCZYK M.A.

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1801165923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JESSICA LAUREN KRAWCZYK M.A.

Provider Business Mailing Address
First Line	:	721 S QUENTIN RD
Second Line	:	SUITE 103
City	:	PALATINE
State	:	IL
Zip	:	60067-6778
Country	:	US
Telephone Number	:	847-359-7490
Fax Number	:	847-359-7525

Provider Business Practice Location Address
First Line	:	721 S QUENTIN RD
Second Line	:	SUITE 103
City	:	PALATINE
State	:	IL
Zip	:	60067-6778
Country	:	US
Telephone Number	:	847-359-7490
Fax Number	:	847-359-7525

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

Provider Enumeration Date	:	12/19/2011
Last Update Date	:	12/19/2011

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