MEDICARE: MR. DAVID AMBROSE HODGSON L.C.S.W.

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	1041C0700X	Clinical Social Worker	149.003641	IL

General Provider Information

NPI Number	:	1003957762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID AMBROSE HODGSON L.C.S.W.

Provider Business Mailing Address
First Line	:	1226 E MADISON PARK APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-2959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1226 E MADISON PARK
Second Line	:	#2
City	:	CHICAGO
State	:	IL
Zip	:	60615-2959
Country	:	US
Telephone Number	:	708-351-3137
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	01/20/2022

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