MEDICARE: JUVENILE PROTECTIVE ASSOCIATION

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1972567709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUVENILE PROTECTIVE ASSOCIATION

Provider Business Mailing Address
First Line	:	1333 N KINGSBURY ST
Second Line	:	SUITE 306
City	:	CHICAGO
State	:	IL
Zip	:	60622-2687
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-5501
Country	:	US
Telephone Number	:	312-440-1203
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	RICHARD CALICA
Credential	:
Telephone Number	:	312-698-6940

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	08/22/2020

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