MEDICARE: MS. JANE ANN BENNETT-ELIAS 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	180004275	IL

General Provider Information

NPI Number	:	1962530188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANE ANN BENNETT-ELIAS LCPC

Provider Business Mailing Address
First Line	:	2650 W MONTROSE AVE STE 102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1562
Country	:	US
Telephone Number	:	773-377-5261
Fax Number	:	872-813-4596

Provider Business Practice Location Address
First Line	:	2650 W MONTROSE AVE STE 102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1562
Country	:	US
Telephone Number	:	773-377-5261
Fax Number	:	872-813-4596

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	01/05/2024

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