MEDICARE: MS. EMMA B. COATE LCSW

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	104100000X	Social Worker	150.009957	IL
2	1041C0700X	Clinical Social Worker	149015018	IL
3	1041C0700X	Clinical Social Worker	149.015018	IL

General Provider Information

NPI Number	:	1013108224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMMA B. COATE LCSW

Provider Business Mailing Address
First Line	:	1438 E 55TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-5420
Country	:	US
Telephone Number	:	773-970-9708
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 E 53RD ST STE 933
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4572
Country	:	US
Telephone Number	:	773-219-0605
Fax Number	:

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

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	01/14/2022

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