MEDICARE: AMELIORATED WEALTH OF WISDOM

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1821451477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMELIORATED WEALTH OF WISDOM

Provider Business Mailing Address
First Line	:	1158 W TAYLOR ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4213
Country	:	US
Telephone Number	:	773-301-5061
Fax Number	:

Provider Business Practice Location Address
First Line	:	1158 W TAYLOR ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4213
Country	:	US
Telephone Number	:	773-301-5061
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN CEO
Name	:	YASMEEN STRUDIVANT
Credential	:	ELDER
Telephone Number	:	773-301-5061

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	03/31/2016

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Directions to “AMELIORATED WEALTH OF WISDOM ” Practice Location

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