MEDICARE: MRS. JAMIE SUZANNE PEKAREK KROHN 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01636614	OTHER	IL	BCBSIL

General Provider Information

NPI Number	:	1972663219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE SUZANNE PEKAREK KROHN LCPC

Provider Business Mailing Address
First Line	:	1229 W FOSTER AVE
Second Line	:	3W
City	:	CHICAGO
State	:	IL
Zip	:	60640-2260
Country	:	US
Telephone Number	:	773-506-9224
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 N MICHIGAN AVE
Second Line	:	SUITE 510
City	:	CHICAGO
State	:	IL
Zip	:	60601-7511
Country	:	US
Telephone Number	:	312-238-9050
Fax Number	:

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

Provider Enumeration Date	:	12/09/2006
Last Update Date	:	07/08/2007

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