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NPI Code Detail

MEDICARE: JEWEL DAWN DAVIES LCPC

MEDICARE: JEWEL DAWN DAVIES 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
1101YM0800XMental Health CounselorIL

General Provider Information

NPI Number : 1952448177
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEWEL DAWN DAVIES LCPC
Provider Business Mailing Address
First Line : 744 W GORDON TER
Second Line : UNIT 101
City : CHICAGO
State : IL
Zip : 60613-2270
Country : US
Telephone Number : 773-975-0477
Fax Number : 708-974-5114
Provider Business Practice Location Address
First Line : 10537 S ROBERTS RD
Second Line :
City : PALOS HILLS
State : IL
Zip : 60465-1933
Country : US
Telephone Number : 708-974-5114
Fax Number : 708-974-2498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 07/08/2007

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