| Amy Bazelon Lcpc, Llc | |
|
839 Moseley Rd Highland Park IL 60035-4635 | |
| (847) 707-5424 | |
| Not Available |
| Full Name | Amy Bazelon Lcpc, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 839 Moseley Rd, Highland Park, Illinois |
| Authorized Official Name and Position | Amy Bazelon (MEMBER) |
| Authorized Official Contact | 8477075424 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Amy Bazelon Lcpc, Llc 839 Moseley Rd Highland Park IL 60035-4635 Ph: (847) 432-8968 | Amy Bazelon Lcpc, Llc 839 Moseley Rd Highland Park IL 60035-4635 Ph: (847) 707-5424 |
| NPI Number | 1124521430 |
|---|---|
| Provider Enumeration Date | 03/13/2018 |
| Last Update Date | 10/28/2021 |
| Certification Date | 10/27/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124521430 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 180.010546 (Illinois) | Primary |
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