MEDICARE: A.S.S.I.S.T. OF PALOS HEIGHTS, INC.

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

General Provider Information

NPI Number	:	1861427387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A.S.S.I.S.T. OF PALOS HEIGHTS, INC.

Provider Business Mailing Address
First Line	:	7808 W COLLEGE DR
Second Line	:	LOWER LEVEL STE 3
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1027
Country	:	US
Telephone Number	:	708-261-3544
Fax Number	:	708-361-4460

Provider Business Practice Location Address
First Line	:	7808 W COLLEGE DR
Second Line	:	LOWER LEVEL STE 3
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1027
Country	:	US
Telephone Number	:	708-261-3544
Fax Number	:	708-361-4460

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MS. DAWNMARIE WAGNER
Credential	:	MA, LCPC
Telephone Number	:	708-261-3544

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/22/2020

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