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NPI Code Detail

MEDICARE: MRS. MORGAN VANCE LCSW

MEDICARE:  MRS. MORGAN  VANCE  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
11041C0700XClinical Social Worker7900-123WI

General Provider Information

NPI Number : 1114012812
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MORGAN VANCE LCSW
Provider Business Mailing Address
First Line : 4043 N RAVENSWOOD AVE STE 216-6
Second Line :
City : CHICAGO
State : IL
Zip : 60613-1155
Country : US
Telephone Number : 414-704-9645
Fax Number :
Provider Business Practice Location Address
First Line : 4043 N RAVENSWOOD AVE STE 216-6
Second Line :
City : CHICAGO
State : IL
Zip : 60613-1155
Country : US
Telephone Number : 414-704-9645
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 04/16/2024

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Directions to “ MRS. MORGAN VANCE LCSW” Practice Location

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