MEDICARE: MR. JOHN LOWELL BROM MSW, 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	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1154461226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN LOWELL BROM MSW, LCSW

Provider Business Mailing Address
First Line	:	2463 GEORGETOWN CIR
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60503-6719
Country	:	US
Telephone Number	:	630-664-3941
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 COMMERCE CT STE 310
Second Line	:
City	:	LISLE
State	:	IL
Zip	:	60532-3698
Country	:	US
Telephone Number	:	630-544-3324
Fax Number	:	630-544-3325

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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