Mrs Nicole Perry, | |
40 N Broadway St, Coal City, IL 60416-1688 | |
(630) 352-7267 | |
Not Available |
Full Name | Mrs Nicole Perry |
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Gender | Female |
Speciality | Counselor - Professional |
Location | 40 N Broadway St, Coal City, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1083006563 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | 178009414 (Illinois) | Primary |
Entity Name | 515 Fitness Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1134508310 PECOS PAC ID: 6103172341 Enrollment ID: O20180702001423 |
Mailing Address | Practice Location Address |
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Mrs Nicole Perry, 40 N Broadway St, Coal City, IL 60416-1688 Ph: (630) 352-7267 | Mrs Nicole Perry, 40 N Broadway St, Coal City, IL 60416-1688 Ph: (630) 352-7267 |
Alexandra Marie Stauber, LSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 295 W Division St, Coal City, IL 60416 Phone: 630-915-8758 | |
Monica Molesky, Counselor Medicare: Not Enrolled in Medicare Practice Location: 295 Division Street, Coal City, IL 60416 Phone: 815-515-0010 | |
Tracy Stone, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 295 W Division St, Coal City, IL 60416 Phone: 815-515-0010 | |
Jenna Valentine, Counselor Medicare: Not Enrolled in Medicare Practice Location: 40 N Broadway Street, Coal City, IL 60416 Phone: 630-352-7267 | |
Erica Robin Krahl, MA Counselor Medicare: Not Enrolled in Medicare Practice Location: 275 S Broadway St, Suite 2, Coal City, IL 60416 Phone: 815-634-3994 Fax: 815-634-2738 | |
Mckenzie Mieszkowski, LCPC, CADC Counselor Medicare: Not Enrolled in Medicare Practice Location: 40 N Broadway St, Coal City, IL 60416 Phone: 224-335-7413 |