MEDICARE: DASI GINNIS AND ASSOCIATES, LLC

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

General Provider Information

NPI Number	:	1083187769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DASI GINNIS AND ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	3139 N LINCOLN AVE STE 228
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3173
Country	:	US
Telephone Number	:	773-243-9421
Fax Number	:

Provider Business Practice Location Address
First Line	:	3139 N LINCOLN AVE STE 228
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3173
Country	:	US
Telephone Number	:	773-243-9421
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DASI D GINNIS
Credential	:	LCSW
Telephone Number	:	773-243-9421

Provider Enumeration Date	:	01/06/2019
Last Update Date	:	01/06/2019

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