MEDICARE: ASPIRE INTEGRATED HEALTH, PLLC

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1871142869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRE INTEGRATED HEALTH, PLLC

Provider Business Mailing Address
First Line	:	4114 N WATER TOWER PL STE F
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6548
Country	:	US
Telephone Number	:	618-634-7753
Fax Number	:	618-216-1492

Provider Business Practice Location Address
First Line	:	4114 N WATER TOWER PL STE F
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6548
Country	:	US
Telephone Number	:	618-634-7753
Fax Number	:	618-216-1492

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	AMBER PHELPS SCHWEDA
Credential	:	LCPC
Telephone Number	:	618-634-7753

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

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