| Changing Phases, Llc | |
|
142 Hawley St Ste 1 Grayslake IL 60030-3653 | |
| (224) 421-6235 | |
| (630) 349-8131 |
| Full Name | Changing Phases, Llc |
|---|---|
| Speciality | Counselor |
| Location | 142 Hawley St Ste 1, Grayslake, Illinois |
| Authorized Official Name and Position | Justin William Schloer (MEMBER) |
| Authorized Official Contact | 2244216235 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Changing Phases, Llc 142 Hawley St Ste 1 Grayslake IL 60030-3653 Ph: (224) 421-6235 | Changing Phases, Llc 142 Hawley St Ste 1 Grayslake IL 60030-3653 Ph: (224) 421-6235 |
| NPI Number | 1144802521 |
|---|---|
| Provider Enumeration Date | 04/25/2021 |
| Last Update Date | 03/08/2024 |
| Certification Date | 03/08/2024 |
| Medicare PECOS PAC ID | 8426422924 |
|---|---|
| Medicare Enrollment ID | O20230324000448 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144802521 | NPI | - | NPPES |
| Provider Name | Rebekah Erin Dickey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366140311 PECOS PAC ID: 3971977489 Enrollment ID: I20230324000526 |
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