MEDICARE: JULIE TRYTEK VAGUE MA, LCPC, CADC

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	180.008006	IL

General Provider Information

NPI Number	:	1871860783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE TRYTEK VAGUE MA, LCPC, CADC

Provider Business Mailing Address
First Line	:	1211 LONGFORD CIR
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60120-4829
Country	:	US
Telephone Number	:	708-837-3701
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 LONGFORD CIR
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60120-4829
Country	:	US
Telephone Number	:	708-837-3701
Fax Number	:

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

Provider Enumeration Date	:	11/20/2011
Last Update Date	:	11/20/2011

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