MEDICARE: NATALIE WOULF 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	180.012451	IL

General Provider Information

NPI Number	:	1861042806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE WOULF LCPC

Provider Business Mailing Address
First Line	:	1711 W JARVIS AVE APT 304
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-7616
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 N LINCOLN AVE STE 206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2422
Country	:	US
Telephone Number	:	720-253-3300
Fax Number	:

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

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	09/11/2019

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