MEDICARE: MRS. KRISTINE GONYON MA

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1972802692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINE GONYON MA

Provider Business Mailing Address
First Line	:	700 N SACRAMENTO BLVD
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60612-1046
Country	:	US
Telephone Number	:	773-318-7454
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 N SACRAMENTO BLVD
Second Line	:	SUITE 220
City	:	CHICAGO
State	:	IL
Zip	:	60612-1046
Country	:	US
Telephone Number	:	773-318-7454
Fax Number	:

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

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	03/21/2011

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